A national standard for asking about alcohol, not just advising against it

The Society of Obstetricians and Gynaecologists of Canada has issued Clinical Practice Guideline No. 471 on alcohol and pregnancy, covering screening and counselling for pregnant women and for women of childbearing age. Evidence was drawn from Medline, EMBASE and CENTRAL for the period October 2018 to February 2026, and recommendations are GRADE-rated for both quality of evidence and strength.

The substance is less about the abstinence message, which is not in dispute, and more about the mechanics of finding the problem. The guideline pushes validated screening tools and brief intervention rather than an open question at booking, and it is explicit that obstetric providers need expedited referral pathways to clinicians with alcohol cessation expertise — the point being that recognition without a route to treatment achieves little.

In Indian practice the referral half of that is often the harder half. Where a formal de-addiction pathway does not exist locally, the useful move is to identify one named contact before you need them, rather than at the visit where screening turns positive.

• Use a validated screening tool at booking rather than a general question about drinking
• Screen women of reproductive age presenting for contraception or preconception advice, not only those already pregnant
• Have a named cessation or de-addiction contact identified in advance of needing one
• Record what was asked and what was answered — a positive screen at booking is often the only chance
• Brief intervention is part of the obstetric consultation, not something to be deferred to a referral

Why it matters

The gap this addresses is not what to advise, but whether anyone is systematically asking.

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