Preventing alcohol-exposed pregnancies: a randomized controlled trial

Abstract

Background: Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States.

Design: A randomized controlled trial (2002-2005; data analyzed 2005-2006) of a brief motivational intervention to reduce the risk of an alcohol-exposed pregnancy (AEP) in preconceptional women by focusing on both risk drinking and ineffective contraception use.

Setting/participants: A total of 830 nonpregnant women, aged 18-44 years, and currently at risk for an AEP were recruited in six diverse settings in Florida, Texas, and Virginia. Combined settings had higher proportions of women at risk for AEP (12.5% overall) than in the general population (2%).

Interventions: Participants were randomized to receive information plus a brief motivational intervention (n=416) or to receive information only (n=414). The brief motivational intervention consisted of four counseling sessions and one contraception consultation and services visit.

Main outcome measures: Women consuming more than five drinks on any day or more than eight drinks per week on average, were considered risk drinkers; women who had intercourse without effective contraception were considered at risk of pregnancy. Reversing either or both risk conditions resulted in reduced risk of an AEP.

Results: Across the follow-up period, the odds ratios (ORs) of being at reduced risk for AEP were twofold greater in the intervention group: 3 months, 2.31 (95% confidence interval [CI]=1.69-3.20); 6 months, 2.15 (CI=1.52-3.06); 9 months, 2.11 (CI=1.47-3.03). Between-groups differences by time phase were 18.0%, 17.0%, and 14. 8%, respectively.

Conclusions: A brief motivational intervention can reduce the risk of an AEP.

Figure 1

Study flow. *The following inclusion criteria categories are not mutually exclusive: 1398 did not meet drinking criteria, 3019 did not meet pregnancy-risk criteria, 826 had other exclusion reasons (moving out of town, unable to understand English, out of age range). **IPC, intervention group; IO, control group.

Figure 2

Distribution of choices selected by women who achieved reduced AEP risk by control (IO)* and intervention (IPC) groups. A, women who used effective contraception only; B, women who reduced risk-drinking only; AB, women who both used effective contraception and reduced risk drinking. *IO, information only; IPC, information plus counseling. Only women who provided information on both contraception and alcohol behavior are included in these counts.