Patients received general information regarding adverse effects of alcohol and the prevalence of problem drinking, in addition to tools to help them identify drinking triggers and track their consumption. The patient and physician developed a “drinking agreement” in the form of a rescription. Men and non pregnant women were included in this study.
Women reduced their alcohol use by 47% and their frequency of binge drinking by 56%, as noted at a 6-month follow-up, with changes well maintained at 12 months. The reductions for female patients were actually slightly higher than for male participants.22
Chang and colleagues provided a 25-minute single session brief intervention to pregnant women who had screened positive on the T-ACE questionnaire with a score of 2 or more, and were identified as being at risk for prenatal alcohol use.23 Participants were randomly assigned to the intervention group or a control group. Both the control group and the brief intervention group decreased their use of alcohol after enrolling in the study and undergoing the initial detailed assessment.
For women who were heavier drinkers, the brief interventions for prenatal alcohol use were statistically more effective in reducing their frequency of alcohol consumption, vs the initial assessment alone. In addition, the effects of the brief intervention were significantly enhanced when a support partner of the woman’s choice also participated.23
The Project Choices Intervention Research Group studied an intervention that included 4 sessions of motivational interviewing regarding alcohol habits, and a contraception counseling session.24 Study participants were recruited from 6 community-based settings with high proportions of women at risk for an alcohol-exposed pregnancy, including a jail and 2 drug and alcohol treatment centers. Among the 143 women who completed the 6-month follow-up, 68.5% were no longer at risk of having an alcohol-exposed pregnancy.
These participants successfully lowered their risk by reducing alcohol use only (12.9%), adopting appropriate contraception use only (23.1%), or by changing both risk factors (32.9%). Even if all the study participants who were lost to follow-up were assumed to have been unsuccessful at eliminating their risk of alcohol-exposed pregnancy, more than half of the women (51.6%) successfully changed.24
Take advantage of opportunities
FAS is the most severe consequence of alcohol-exposed pregnancy, leaving the affected child with a lifelong disability. As a family physician, you have access to easy-touse, cost-effective clinical tools to screen for at-risk drinking behaviors and have sufficient rapport with your patients to encourage effective contraceptive practices. You also have effective tools for helping patients reduce their alcohol consumption.
Within the context of your long-term relationships with patients, you can provide brief interventions that include factual information and opportunities for goal setting. You can assist families with an FAS child to access services, manage medically related complications, and plan for special education and vocational skills training.
Recognition that 1 child in a family is affected by prenatal alcohol exposure gives you another window of opportunity to address the underlying substance use issues in the mother and the family, increasing the odds that future pregnancies will not be alcohol exposed.
CORRESPONDENCE Mary C. Boyce, MD, Wesley Family Medicine Residency, 850 N. Hillside, Wichita, KS 67214; Mary.Boyce@wesleymc.com