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One session can lower prenatal alcohol use.

TORONTO -- A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that "screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention," according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a four-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors.

"We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety," Dr. Chang said. "But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy."

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. "It was not uncommon to hear women say their goal was to have 'just one drink' per week--and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy," Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, "such as having something to eat or having a fake drink," Dr. Chang said. "We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently." Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since the time of enrollment. "We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another," Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, "there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled," Dr. Chang said. "Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent."

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. "The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment," she said. Additionally, "the intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, as most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor."

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. "We found that the strongest predictor was alcohol use at the previous time--lifetime use predicted early pregnancy use, and so on," Dr. Chang said. "Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor, which is often the case in psychiatry--knowing the right thing to do doesn't mean someone will do it."


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Author:Mahoney, Diana
Publication:Clinical Psychiatry News
Geographic Code:1CANA
Date:Aug 1, 2006
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