Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy

J Obstet Gynaecol Can. 2020 Sep;42(9):1158-1173.e1. doi: 10.1016/j.jogc.2020.03.002.


Objective: To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence.

Intended users: Health care providers who care for pregnant women and women of child-bearing age.

Target population: Pregnant women and women of child-bearing age and their families.

Evidence: Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus.

Validation methods: The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework.

Benefits, harms, costs: Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes.

Summary statements (grade ratings in parentheses): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Keywords: alcohol drinking; alcohol-related disorders; fetal alcohol spectrum disorders; prenatal care; substance abuse detection.

Publication types

  • Practice Guideline

MeSH terms

  • Alcohol Drinking / adverse effects*
  • Alcohol Drinking / prevention & control
  • Alcohol Drinking / psychology
  • Alcoholism / diagnosis*
  • Alcoholism / psychology
  • Canada
  • Child
  • Counseling*
  • Female
  • Humans
  • Mass Screening*
  • Pregnancy
  • Prenatal Care*
  • Prenatal Exposure Delayed Effects