Alcohol Screening in Pregnancy

Drinking at any time during pregnancy can cause problems to the fetus. Alcohol travels from the mother's blood stream to the fetus through the placenta. No one knows the amount of alcohol it takes to cause birth defects. However, the more alcohol the pregnant woman drinks, the more it harms the fetus. Drinking alcohol when pregnant increases the risk of miscarriage and Fetal Alcohol Syndrome (FAS). It is advised not to drink any kind of alcohol when pregnant. The following are three screening tests that may be used to detect alcohol risk in pregnancy.


T-ACE is a screening instrument that can identify women's prenatal consumption. T-ACE is proven to be a valuable and efficient tool for identifying a range of alcohol use, including any current prenatal alcohol consumption, prepregnancy risk drinking (defined as more than 2 drinks per drinking day), and lifetime alcohol diagnoses.

  • T: Tolerance. How many drinks* does it take to make you feel high?

  • A: Have people Annoyed you by criticizing your drinking?

  • C: Have you ever felt you should Cut down on your drinking?

  • E: Eye opener. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

*Defined as the consumption of 1 ounce or more of alcohol per day while pregnant.

Scores are calculated as follows:

  • A reply of more than 2 drinks to question T is considered a positive response and scores 2 points.

  • A positive answer to question A, C, or E scores 1 point each.

  • A total score of 2 or more points on the T-ACE indicates a positive outcome for pregnancy risk drinking.

If you scored 2 points or higher, your caregiver can guide you to help improve the outcome of your pregnancy.


TWEAK is used to screen for at-risk drinking defined as the consumption of 1 ounce or more of alcohol per day while pregnant. A total score of 2 or more indicates a positive screen for pregnancy risk drinking.

  • T: Tolerance. How many drinks can you hold?

  • If 5 or more = 2 points.

  • W: Have people Worried or complained about your drinking in the past year? 

  • Yes = 2 points.

  • E: Eye opener. Do you sometimes have a drink in the morning when you get up?

  • Yes = 1 point.

  • A: Amnesia. Have you been told about things you said or did while drinking that you could not remember?

  • Yes = 1 point.

  • K: Do you sometimes feel you need to cut down on your drinking?

  • Yes = 1 point.


The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published The Physician's Guide to Helping Patients with Alcohol Problems. This guide presents a brief model for screening and assessing problems with alcohol. NIAAA recommends screening for alcohol-related problems during routine health exams, before prescribing a medicine that interacts with alcohol, and in response to the discovery of medical problems that may be related to alcohol use.

  • Do you drink?

  • Do you use drugs?

  • On average, how many days per week do you drink alcohol (beer, wine, or liquor)?

  • On a typical day when you drink, how many drinks do you have?

  • Positive score: more than 14 drinks for men and more than 7 for women.

  • What is the maximum number of drinks you had on any given occasion during the past month?

  • Positive score: more than 4 for men and more than 3 for women.