Sample Screen for Prenatal Alcohol Exposure
The following screen for prenatal alcohol exposure has a variety of important questions. The screen is meant to normalize information collection with a choice of generalized questions. Be aware to avoid reactions that might indicate judgement if a woman acknowledges prenatal alcohol use. Remind the parents that the information will help to guide the child’s care.
“Now that we have [child’s name] medical history, let’s talk about the pregnancy. This will help me get to know [child’s name] and your family better.”
“How far along were you before you found out that you were pregnant with child’s name?”
“Did you have any medical conditions or concerns during the pregnancy?”
“Did you experience any anxiety or depression during the pregnancy?”
“Now I am going to move onto a series of questions that I ask all women about their use of tobacco, alcohol, prescription and non-prescription drugs during pregnancy.”
“Before you knew you were pregnant, how much alcohol (beer, wine, liquor, etc.) did you drink?”
If the mother shows concern that she drank before she knew she was pregnant, reassure her that she is not alone in doing so and that awareness allows for monitoring, moving forward, and intervention if needed.
“After you found out you were pregnant, how much alcohol did you drink? ”
“Were there any prescription or non-prescription drugs that you took while pregnant?”
If yes: “Can you tell me the names of the drugs and how often you took them?”
“Has there been a time when you smoked cigarettes?”
If yes: “During the pregnancy how often did you smoke any cigarettes?”
“Is this your first pregnancy?”
If no: “Tell me about the other pregnancies.”
”Was [child’s name] born full term? ”
Ask questions about the delivery and solicit any neonatal information that has not been discussed earlier.
“Is there anything else that you might want to tell me about your pregnancy with [child’s name]?”