Alcohol and Benzo Screening and Withdrawal Management in Pregnancy

It is beyond the scope of MOMCARE at this time to provide extensive guidance about non-opioid substance use in pregnancy. However, if a pregnant individual is using alcohol or benzodiazepines, special care must be taken to avoid dangerous complications for the patient and fetus.

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Key Points

HOW

  • Screen everyone for alcohol and benzodiazepine use. Not everyone who uses alcohol or benzos will withdraw, but because of the risk, anyone reporting recent use (7 days) must be assessed for withdrawal symptoms.
  • Screen for alcohol use. We recommend the Alcohol Quantity and Drinking Frequency Questions from NIAA:
    • “In a typical week, how many drinks do you have that contain alcohol?” If more than 7 drinks, POSITIVE SCREEN.
    • “In the past 3 months, how many times have you had more than 3 alcoholic drinks on any one occasion?” If more than once, POSITIVE SCREEN
    • If positive screen>, ask when their last drink was. If within the last 7 days, at RISK FOR WITHDRAWAL.
  • Screen for Benzo use.
    • “Do you take any sedatives or benzos that are not prescribed by a doctor?” If YES, ask how much and when the last use was. If they use it daily or almost daily and have used within the past 7 days, at RISK FOR WITHDRAWAL.
    • If the patient is prescribed benzodiazepines, then they should be continued on this as with any other medication.
  • In most cases, we recommend TRANSPORTING TO A HOSPITAL for pregnant patients at risk for alcohol and/or benzo withdrawal for assessment and initial management.
  • Proceed with screening for other substance use in pregnancy.


WHY

  • Some pregnant patients may present with polysubstance use. Jail staff must for multiple substances to provide the appropriate care.
  • Withdrawal from alcohol and benzos can be deadly for the mom and fetus if not treated.
  • Alcohol use in pregnancy is more common than people think. Drinking alcohol while pregnant can have severe negative outcomes for the fetus including intellectual disability and birth defects.
  • Benzodiazepines or “benzos” are medications that relieve anxiety, muscle spasms, and seizures, and can also cause sedation. Benzos can be prescribed but can also be abused with or without a prescription.

KEEP IN MIND

  • Remember, a drug test is not a parenting test. If someone screens positive, this does not mean they cannot parent, but they should be referred for services. And, being in jail while pregnant doesn’t mean they are a bad parent.
  • Just like opioid use, pregnant patients may be reluctant to share they are using alcohol and Benzos due to fear of stigma and judgment.
  • If alcohol and benzo use are identified, refer to a medical provider for assessment IMMEDIATELY, regardless of the risk of withdrawal.
  • Review the urgent maternal warning signs and educational materials on being pregnant/postpartum with OUD with patients. Educate your patients about these symptoms so they are aware while in jail and in the community. 

Deeper Dive

HOW

Not everyone who uses alcohol or benzos will develop withdrawal, but because of the risk anyone reporting recent use (7 days) must be assessed for withdrawal symptoms.


How should jail staff assess alcohol use in pregnancy?

Screen for alcohol use. There are many questionnaires, such as the TACE. We recommend the Alcohol Quantity and Drinking Frequency Questions from NIAA:

  • “In a typical week, how many drinks do you have that contain alcohol?” If more than 7 drinks, POSITIVE SCREEN.
  • “In the past 3 months, how many times have you had more than 3 alcoholic drinks on any one occasion?”  If more than once, POSITIVE SCREEN.
  • If screened positive, ask when their last drink was. If within the last 7 days, at RISK FOR WITHDRAWAL.


How should jail staff assess Benzo use during pregnancy?

Screen for Benzo use.

  • “Do you take any sedatives or benzos that are not prescribed by a doctor?” If YES, ask how much and when the last use was. If they use it daily or almost daily and have used it within the past 7 days, at RISK FOR WITHDRAWAL.
  • If the patient is prescribed benzodiazepines for medical indication, then they should be continued on this as with any other medication.


What should jail staff do if a pregnant patient screens positive for alcohol or Benzo use?

In most cases, we recommend TRANSPORT TO HOSPITAL for pregnant patients at risk for alcohol and/or benzo withdrawal for assessment and initial management.

If your jail is properly staffed with people with training and experience managing alcohol and benzo withdrawal in pregnant patients, including recognition of when patients need to be referred and staffing to do frequent withdrawal assessments and dosing of benzo taper, then some patients who do not appear unwell may be able to stay on site. See the BJA training video (7 mins) on how to identify if someone in jail is unwell. 

  • All patients who are pregnant and appear unwell or have urgent maternal warning signs should be transferred to the hospital, regardless of jail staffing
  • Benzodiazepine taper is the preferred medication treatment for pregnant patients with alcohol or benzo withdrawal.


How should jail staff assess alcohol and Benzo withdrawal symptoms?

Score withdrawal symptoms using a validated tool:


What other services should pregnant patients who use alcohol and Benzos be connected to?

Connect patients to behavioral health treatment, recovery groups, and other support services, support groups (including mutual aid groups). Counsel patients on the risks to the fetal physical and intellectual development of alcohol use in pregnancy.


WHY 

How common is alcohol use in pregnancy?

Alcohol use in pregnancy is more common than people think. The CDC reports that 14% of pregnant individuals report current drinking and 5% report binge drinking.

Alcohol exposure in pregnancy is a leading cause of preventable intellectual disability and birth defects in the U.S. Here is more information on the risks of moderate and heavy drinking in pregnancy.


What are benzodiazepines?

Benzodiazepines or “benzos” are medications that relieve anxiety, muscle spasms, and seizures, and can also cause sedation. While they can be prescribed, many people misuse prescribed or non-prescribed benzos. Some examples are Valium, Xanax, Ativan, and Klonopin.


Why is it important to screen for alcohol and Benzos use in pregnancy?

Withdrawal from alcohol or benzos, if not properly treated, can be deadly and lead to maternal and fetal complications in pregnancy.

Treating alcohol and benzo withdrawal symptoms with medications and connecting them to recovery resources is essential for the health of the mother and fetus.

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