Findings of a pilot study of motivational interviewing with pregnant drinkers. Brief intervention for alcohol use by pregnant women. Reducing alcohol-exposed pregnancy risk in college women: initial outcomes of a clinical trial of a motivational intervention. Preventing alcohol-exposed pregnancies: a randomized controlled trial.
Cost-effective interventions are needed for counseling pregnant drinkers, in order to reduce risk of fetal alcohol effects.
                42 pregnant women who reported alcohol consumption participated in this pilot study of motivational interviewing. Following a comprehensive alcohol use assessment, the participants were randomly assigned to receive either written information about the risks related to drinking during pregnancy or a one-hour motivational interview. The motivational interview was an empathic, client-centered, but directive session focusing on the health of the participants' unborn babies.
                At the end of a 2-month follow-up period, the 34 women (81%) who remained in the study showed a significant reduction in alcohol consumption and peak intoxication levels. Women who had reported the highest blood alcohol concentration (BAC) levels during early pregnancy showed a significantly greater reduction in their estimated BACs at follow-up (during later pregnancy) if assigned to the treatment rather than the control condition.
                Motivational interviewing shows promise as a specific intervention for initiating a reduction in drinking among pregnant women who are at greatest risk. Simpler assessment and advice may suffice for women with lower initial consumption levels. We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention.
                Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed.
                Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition.
                The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies. A significant number of college women are at risk for alcohol-exposed pregnancy (AEP) owing to binge drinking paired with using contraception ineffectively. This article describes a randomized controlled trial of a one-session motivational interviewing-based intervention to reduce AEP risk among college women and presents 1-month outcomes demonstrating the early impact of this intervention. There were 228 female students from a mid-Atlantic urban university enrolled in the trial. Eligibility criteria were being in the age range of 18-24 years and being at risk for AEP. Risk for AEP was defined as having sexual intercourse with a man in the past 90 days while using contraception ineffectively (no use, incorrect use of an effective method, or use of an ineffective method only); drinking at risky levels was defined as engaging in at least one binge in the past 90 days or consuming an average of eight standard drinks per week. One-month outcome data were available for 212 of the 228 enrolled women (a follow-up rate of 93%), with complete data available for 105 women assigned to the control condition and 94 assigned to the intervention condition. At 1-month follow-up, 15% of the control subjects and 25% of the intervention women reported no risk drinking, a significant difference favoring the intervention group. Significantly fewer control subjects (48%) used effective contraception at 1-month follow-up as compared with intervention women (64%), chi(2)(1) = 5.1, p < .03. Significantly more intervention women (74%) were no longer at risk for AEP at 1 month as compared with control subjects (54%), chi(2)(1) = 8.15, p < .005. Factors that were associated with continued AEP risk at 1-month follow-up were a higher number of standard drinks per day consumed in the month prior to baseline (odds ratio, 1.1) and assignment to the control condition (odds ratio, 2.9). The risks of unintended pregnancy and AEP among drinking women in college merit greater prevention efforts. The results of this study show the promise of one preventive intervention that warrants additional study. Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States.
                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.
                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%).
                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.
                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.
                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.
                A brief motivational intervention can reduce the risk of an AEP.
The evidence from the limited number of studies suggests that psychological and educational interventions may result in increased abstinence from alcohol, and a reduction in alcohol consumption among pregnant women. However, results were not consistent, and the paucity of studies, the number of total participants, the high risk of bias of some of the studies, and the complexity of interventions limits our ability to determine the type of intervention which would be most effective in increasing abstinence from, or reducing the consumption of, alcohol among pregnant women.