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Obstet Gynecol. 2010 Oct;116(4):827-33. doi: 10.1097/AOG.0b013e3181ed8290.

Screening for prenatal substance use: development of the Substance Use Risk Profile-Pregnancy scale.

Author information

1
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA. Kimberly.Yonkers@yale.edu

Abstract

OBJECTIVE:

To report on the development of a questionnaire to screen for hazardous substance use in pregnant women and to compare the performance of the questionnaire with other drug and alcohol measures.

METHODS:

Pregnant women were administered a modified TWEAK (Tolerance, Worried, Eye-openers, Amnesia, K[C] Cut Down) questionnaire, the 4Ps Plus questionnaire, items from the Addiction Severity Index, and two questions about domestic violence (N=2,684). The sample was divided into "training" (n=1,610) and "validation" (n=1,074) subsamples. We applied recursive partitioning class analysis to the responses from individuals in the training subsample that resulted in a three-item Substance Use Risk Profile-Pregnancy scale. We examined sensitivity, specificity, and the fit of logistic regression models in the validation subsample to compare the performance of the Substance Use Risk Profile-Pregnancy scale with the modified TWEAK and various scoring algorithms of the 4Ps.

RESULTS:

The Substance Use Risk Profile-Pregnancy scale is comprised of three informative questions that can be scored for high- or low-risk populations. The Substance Use Risk Profile-Pregnancy scale algorithm for low-risk populations was mostly highly predictive of substance use in the validation subsample (Akaike's Information Criterion=579.75, Nagelkerke R=0.27) with high sensitivity (91%) and adequate specificity (67%). The high-risk algorithm had lower sensitivity (57%) but higher specificity (88%).

CONCLUSION:

The Substance Use Risk Profile-Pregnancy scale is simple and flexible with good sensitivity and specificity. The Substance Use Risk Profile-Pregnancy scale can potentially detect a range of substances that may be abused. Clinicians need to further assess women with a positive screen to identify those who require treatment for alcohol or illicit substance use in pregnancy.

LEVEL OF EVIDENCE:

III.

PMID:
20859145
PMCID:
PMC3103106
DOI:
10.1097/AOG.0b013e3181ed8290
[Indexed for MEDLINE]
Free PMC Article
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