Table 1.

Prenatal alcohol exposure screening recommendations for pediatric settings (SUPER)

Support	• Provide empathy and support in a non-judgemental manner.
Universally Screen with Evidence-based screening tool	• Universally screen for PAEa prenatally and in the newborn period; selectively screen throughout childhood. • Embed alcohol screening in routine prenatal questioning regarding other health behaviors prior and during pregnancy: nutrition, vitamin use, physical exercise, and the avoidance of environmental toxins, such as nicotine and second-hand smoke. • To “normalize” the questioning about alcohol use, start with a general statement, like “I ask all my patients' parents standard health questions to understand factors that may affect the health of their child.” • Perform frequent developmental screening if PAE is identified.
Pre-pregnancy and Pregnancy alcohol use	• To approach the topic of alcohol and quickly determine whether prenatal exposure occurred, the following set of questions is recommended:     1. “In the 3 months before you knew you were pregnant, how many times did you have 4 or more alcohol drinks in a day?”     2. “During your pregnancy, how many times did you have any alcohol?” • If a positive response is given to either question above, it is recommended that the clinician follow up to determine the level of PAE by asking:     3. “During your pregnancy, on average, how many days per week did you have any alcohol?”     4. “During your pregnancy, on a typical day when you had an alcoholic beverage, how many drinks did you have?”     5. “During your pregnancy, what was the maximum number of drinks that you had in a day?”
Educate	• Educate women about the risks of alcohol use during pregnancy and advise them to avoid alcohol consumption while pregnant or when conception is possible.
Record, Report, Refer	• Any affirmative answer to above questions indicates maternal at-risk drinking and minimal or higher PAE. • The presence of PAE (pre-pregnancy binge drinking, during pregnancy any alcohol use) and, if possible, the PAE level (during pregnancy the number of drinking days/week, average number of drinks/day, and the maximum number of drinks/day) must be documented in the child's medical record. Documentation of PAE in child's medical records is important for diagnosing ND-PAEb or other FASD condtions at the time of the evaluation or later if disorders become evident later in life. • Guidelines should be followed for the child with PAE, including a referral to a developmental specialist. • Consider legal reporting guidelines for reporting FASDs to Child Welfare; include during regular discussion of treatment consent and disclosure with the family. • If maternal at-risk drinking and PAE is identified, a brief intervention/referral for the mother is indicated to prevent PAE in a future pregnancy and reduce her own health risk.

^aPAE: prenatal alcohol exposure

^bND-PAE: neurobehavioral disorder associated with prenatal alcohol exposure (Data adapted with permission from: Balachova T. Screening for prenatal alcohol exposure. Alcohol Related Neurodevelopmental Disabilities and Prenatal Alcohol Exposure Workgroup Meeting, American Academy of Pediatrics, Elk Grove Village, February 24, 2014) [68].