575: Prenatal risk-drinking screening: T-ACER3 reduces T-ACE false positives

T-ACER3 reduces T-ACE false positives Lisa Chiodo, Robert Sokol, John Hannigan, James Janisse, Grace Patterson, Virginia Delaney-Black Wayne State University School of Medicine, Pediatrics, Detroit, MI, Wayne State University School of Medicine, Obstetrics and Gynecology, Detroit, MI, Wayne State University School of Medicine, Family Medicine, Detroit, MI, Wayne State University School of Medicine, Children’s Research Center of Michigan, Detroit, MI OBJECTIVE: Preventing Fetal Alcohol Spectrum Disorders (FASD) depends on obstetricians detecting maternal risk drinking during antenatal care. ACOG and NIAAA recommend using the T-ACE, an economical/sensitive screen. We have reported that a more stringent T-ACE total score cut-point (3 vs. 2) increased specificity in identifying maternal risk drinking & alcohol-related neurobehavioral dysfunction in children (Chiodo et al, 2010). Our aim was to assess how increasing the T-ACE cut-point could increase efficiency of clinical practice. STUDY DESIGN: Self-reported peri-conceptional & in-pregnancy drinking were assessed with semi-structured interviews and alcohol screens in a prospective sub-sample of 239 African-American mothers given an in-pregnancy T-ACE. The original T-ACE risk criterion (total score of 2) and the revised T-ACER3 criterion with a total score of 3 were analyzed. ANOVA and post-hoc comparisons compared preand in-pregnancy alcohol consumption quantity and frequency measures by risk category. Categories were: 1) No Risk Group (NRG) no risk for pregnancy alcohol use based on both T-ACE and T-ACER3 criteria (n 140); 2) At Risk Group (ARG) based on both T-ACE and T-ACER3 criteria (n 28); and 3) Change Risk Group (CRG) identified as at-risk with the original T-ACE criterion but not at-risk using the revised T-ACER3 criterion (n 71). RESULTS: The 71 women (30%) in the Change Risk Group (CRG) had patterns of alcohol use similar to the no risk group (NRG). As predicted, post-hoc analysis revealed that the at-risk group (ARG) had significantly more alcohol use both prior to and during pregnancy than either the NRG or CRG groups. CONCLUSION: The results provide further evidence that adjusting the T-ACE total score cut-point to 3 in the T-ACER3 is clinically appropriate. Using the T-ACER3 criteria, only 12% of women would require intervention, compared with 41% for T-ACE. Increasing the total T-ACE score criterion from 2 to 3 results in fewer “false positives,” allowing a more intensive targeted clinical response with pregnant women correctly identified by the T-ACER3 as drinking at fetal risk levels. 576 Excess gestational weight gain leads to post-partum weight retention Shilpi Mehta-Lee, Linzhi Xu, Jennifer Lischewski Goel, Mindy Brittner, Peter Bernstein, Karen Bonuck NYU Langone Medical Center, Obstetrics & Gynecology, New York, NY, Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY, UMDNJRobert Wood Johnson Medical School, Medical School, New Brunswick, NJ, Albert Einstein College of Medicine/Montefiore Medical Center, Obstetrics & Gynecology and Women’s Health, Bronx, NY OBJECTIVE: Excessive gestational weight gain (GWG) has been linked to post-partum weight retention and long-term adverse health outcomes. We sought to determine if patients at 2 Bronx health clinics with excess GWG by Institute of Medicine (IOM) guidelines were more likely to have post-partum weight retention than those who gained at or under the recommended guidelines. STUDY DESIGN: Data are from participants in 2 randomized, controlled trials of pre-natal care based breastfeeding interventions. 941 women with 12-26 week, singleton pregnancies, were enrolled from 2008-2010. Those with pre-pregnancy self-reported weight and height, and a post-partum weight available were included. 2009 IOM guidelines were used to define excess GWG by BMI category. Postpartum weight retention was calculated using a measured weight at the first post-partum visit minus self-reported pre-pregnancy weight. Multivariate analysis of covariance was employed to compare the mean post-partum weight retention by normal v. excess GWG. RESULTS: 404 women met inclusion criteria. Demographic characteristics were similar between groups. Women with excess GWG were more likely to have higher pre-pregnancy BMI (28.6[6.2] v. 27.3[6.2]; p 0.041), deliver at a later gestational age (39.2[1.8] v. 38.6[2.4] weeks; p 0.009) and enroll in WIC (54% v 37%; p 0.001). (Table) In multivariate analysis adjusted for age, parity, race, pre-pregnancy BMI, WIC use, employment, education and the number of weeks post-partum, women gaining within recommended IOM guidelines had retained a mean of 7.2 lbs. at their first post-partum visit, whereas those with excess GWG had mean weight retention of 23.7 lbs, a difference of 16.6 lbs (p 0.001). CONCLUSION: In an urban prenatal population, excess GWG was predictive of higher post-partum weight retention regardless of age, weight, BMI, race, socioeconomic indicators, or weeks post-partum. This weight retention can have long-term consequences. This increased risk of weight retention should be added to the list of poor outcomes associated with excess GWG, and interventions are needed to address this issue postpartum. PosterSessionIV Epidemiology, Infectious Disease, Intrapartum Fetal Assessment, Operative Obstetrics, Obstetric Quality & Safety, Public Health-Global Health www.AJOG.org