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Screening Methods for Alcohol Use in Pregnancy Under Review

lite News Desk 2 min read

At a glance

  • Urine dipstick tests in pregnancy showed limited accuracy for alcohol detection
  • Biochemical markers like EtG and PEth identified more cases than self-report
  • SAMHSA recommends confirmatory testing for positive EtG results

Recent studies have examined the effectiveness of various screening methods for detecting alcohol use during pregnancy, highlighting differences in accuracy between biochemical tests and self-reported questionnaires.

Research conducted in Denmark from 2019 to 2020 used urine dipstick screening, followed by confirmatory LC-MS/MS testing, to assess substance use among pregnant women. The study found that while 25% of dipstick tests were initially positive for alcohol, only 44% of these were confirmed by the more specific laboratory method, resulting in a confirmed prevalence of 10.8%.

Another study compared urinary ethyl glucuronide (EtG) assays with self-report questionnaires among pregnant women. The findings indicated that 20.4% of participants exceeded the normalized EtG cut-off, while self-reported questionnaires detected fewer cases, suggesting under-reporting of alcohol use.

Poor concordance was observed between biochemical EtG results and self-reported alcohol consumption, with a kappa value below 0.2. This suggests that questionnaires may substantially under-detect alcohol use during pregnancy compared to biochemical testing.

What the numbers show

  • 10.8% confirmed alcohol use in Danish study using LC-MS/MS testing
  • 20.4% exceeded EtG cut-off in 2022 study, higher than self-reported rates
  • 5.2% of prenatal blood samples had PEth ≥ 2 ng/mL in a 2024 study
  • Combining self-report with PEth testing increased detection by 5.4% over urine ethanol testing

Further research in 2025 assessed rapid urine EtG screening and found that lowering the detection threshold to 100 ng/mL improved identification of alcohol use. In this study, 56.1% of samples classified as ‘uncertain’ and 12.2% of negative samples exceeded the lower cut-off, indicating that rapid EtG tests may detect alcohol use even when self-report is negative.

An observational study in 2024 analyzed 3,000 prenatal blood samples for phosphatidylethanol (PEth), a marker of alcohol exposure over several weeks. The study detected PEth at or above 2 ng/mL in 5.2% of cases and recommended adding PEth 16:0/18:1 screening to routine prenatal blood tests, with follow-up evaluation and retesting for positive results.

A prospective observational study found that combining self-report with PEth testing increased detection of alcohol use in pregnancy by 5.4% compared to self-report plus urine ethanol testing. This suggests that PEth testing may offer greater sensitivity in identifying prenatal alcohol exposure.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued advisories regarding the use of EtG testing, noting its high sensitivity and the possibility of positive results from incidental exposure. SAMHSA recommends that positive EtG findings be confirmed with additional laboratory methods, such as GC/MS or LC/MS/MS, before any consequential decisions are made.

* This article is based on publicly available information at the time of writing.

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