{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T04:45:27Z","timestamp":1782535527318,"version":"3.54.5"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K08 DA061258"],"award-info":[{"award-number":["K08 DA061258"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 DA053507"],"award-info":[{"award-number":["K23 DA053507"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Despite well\u2010documented harms of prenatal alcohol exposure, evidence\u2010based treatment guidelines for alcohol use disorder (AUD) during pregnancy remain limited. We systematically reviewed international clinical practice guidelines to examine how they address the full cascade of AUD care during pregnancy, including diagnosis, engagement, treatment initiation, and retention. We searched over 40 clinical practice guideline databases (including PubMed and Guidelines International Network) and gray literature sources globally, identifying 1045 records. Using the Population, Interventions, Comparators, Attributes, Recommendation Characteristics (PICAR) framework, we evaluated guidelines from medical organizations in English\u2010speaking nations addressing alcohol use and AUD management in pregnancy. Our final analysis included 18 guidelines from the United States, Canada, the United Kingdom, Australia\/New Zealand, and the World Health Organization published from 2014 to the present. Two reviewers independently assessed each guideline using the Appraisal of Guidelines Research and Evaluation\u2010Recommendations Excellence (AGREE\u2010REX) framework to evaluate quality and risk of bias. We used narrative synthesis to summarize findings across key concepts and care cascade stages. Nearly all guidelines (94%) described risks of alcohol exposure and recommended counseling on cessation (89%), yet few extended beyond these early cascade stages. Only 44% mentioned medications for AUD (MAUD), and merely 17% discussed specific psychosocial treatments. Among guidelines addressing MAUD, only one cautiously supported use, while three explicitly recommended against it. Most guidelines (61%) ended treatment recommendations at referral to specialty care, with half limiting guidance to acute alcohol withdrawal management. Taken together, our findings reveal a stark misalignment between screening emphasis and treatment guidance. While guidelines consistently recommend universal screening and brief intervention, they provide minimal actionable frameworks for managing AUD throughout pregnancy. This gap leaves clinicians without evidence\u2010based pathways for comprehensive AUD treatment during the prenatal period, highlighting an urgent need to strengthen both the evidence base and clinical guidance for AUD management in pregnancy.<\/jats:p>","DOI":"10.1111\/acer.70330","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T05:58:27Z","timestamp":1780725507000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Systematic Review of International Guidelines for Addressing Alcohol Use Disorder in Pregnancy"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7396-0446","authenticated-orcid":false,"given":"Caroline B.","family":"Cary","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Washington University School of Public Health  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0559-5335","authenticated-orcid":false,"given":"Emily O.B.","family":"Hynes","sequence":"additional","affiliation":[{"name":"Institute for Drug and Alcohol Studies Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2489-2942","authenticated-orcid":false,"given":"Mishka","family":"Terplan","sequence":"additional","affiliation":[{"name":"Friends Research Institute  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7512-1072","authenticated-orcid":false,"given":"Kelly A.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Gosford Hospital, School of Medicine and Public Health University of Newcastle  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6040-7708","authenticated-orcid":false,"given":"Vitor S.","family":"Tardelli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, St Michael's Hospital University of Toronto Faculty of Medicine  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3555-5228","authenticated-orcid":false,"given":"Thiago M.","family":"Fidalgo","sequence":"additional","affiliation":[{"name":"Departamento de Psiquiatria da Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1310-2826","authenticated-orcid":false,"given":"Jennifer K.","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6664-8924","authenticated-orcid":false,"given":"Michelle","family":"Doering","sequence":"additional","affiliation":[{"name":"Becker Medical Library Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8191-6875","authenticated-orcid":false,"given":"Richard A.","family":"Grucza","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6180-8642","authenticated-orcid":false,"given":"Hendr\u00e9e E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of North Carolina School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7061-4114","authenticated-orcid":false,"given":"Ryan","family":"Duggal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology &amp; Reproductive Sciences UCSF School of Medicine  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4908-4693","authenticated-orcid":false,"given":"Jeannie C.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3059-9993","authenticated-orcid":false,"given":"Silvia S.","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Columbia University Mailman School of Public Health  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-458X","authenticated-orcid":false,"given":"Caitlin E.","family":"Martin","sequence":"additional","affiliation":[{"name":"Institute for Drug and Alcohol Studies Virginia Commonwealth University  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6595-695X","authenticated-orcid":false,"given":"Kevin Young","family":"Xu","sequence":"additional","affiliation":[{"name":"Washington University School of Public Health  St. Louis Missouri USA"},{"name":"Department of Psychiatry Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Center for Advancing Health Services, Policy &amp; Economics Research Washington University in St. Louis  St. Louis Missouri 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