A few nonjudgmental counseling sessions can prompt women to both scale back risky drinking and practice more effective contraception, according to a new study funded by the Centers for Disease Control and Prevention and conducted at six sites in Texas, Virginia and Florida.
Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States. This CDC study explored a strategy that could reduce a woman’s risk of an alcohol-exposed pregnancy.
“A lot of people find this to be an intuitive and sensible approach,” said lead study author Louise Floyd. “If a woman drinks frequently or binge drinks even occasionally, this is not the best time for her to get pregnant, for her or the baby. So why not advocate that she postpone pregnancy until her drinking is reduced?”
The study appears in the January issue of the American Journal of Preventive Medicine.
The 830 study participants were not pregnant but were at high risk for an alcohol-exposed pregnancy because they were binge drinkers (five or more drinks on one occasion) or frequent drinkers (consuming eight or more drinks per week). All of the women were sexually active but were not using reliable measures to prevent pregnancy.
The study tested the effectiveness of motivational interviewing — a kind of supportive yet goal-oriented therapy — to encourage the women to adjust their excessive drinking and ineffective contraception habits.
“What we were able to do was to help the women become aware that they were at risk, and subsequently they made decisions to change their risk behavior,” said Floyd, chief of the Fetal Alcohol Syndrome Prevention Team at the CDC’s National Center on Birth Defects and Developmental Disabilities.
All of the study participants said they were not planning a pregnancy in the near future. But Floyd says about half of all U.S. pregnancies are unplanned.
“If a woman is drinking at risky levels and doesn’t know she is pregnant, the fetus has been exposed to ethanol, a teratogen, in that first eight to 12 weeks when all the fetal organ systems are developing,” Floyd said. A teratogen is any substance that can cause physical or cognitive defects in a fetus.
Half of the study participants received health brochures about the risk of exposing a fetus to alcohol. The other half worked with a trained counselor who offered information and skills to help each woman consider her drinking and contraception habits. During the sessions, the women examined the pros and cons of their behavior. The women were also linked to medical services to obtain birth control, if they were interested.
The research team assessed the women after the motivational interviewing sessions ended. Overall, significantly more women in the intervention group had reduced risky drinking and instituted effective contraception at all three check-in points — three, six and nine months.
Today, intensive preconception counseling on alcohol and contraception use is not part of routine care for women of childbearing age — even for those with drinking problems. But the study found that a woman’s odds of reducing her risk of an alcohol-exposed pregnancy were twofold higher if she received the counseling intervention compared to information only.
In 2005, the surgeon general re-released an advisory urging pregnant women and women considering pregnancy to avoid alcohol to prevent a constellation of developmental problems known as fetal alcohol spectrum disorders.
Grace Chang, an associate professor of psychiatry at Harvard Medical School, said “not every child gets fetal alcohol syndrome. There are all these very subtle neuro-behavioral effects that are lifelong, that are preventable and that are all induced by alcohol.”
“There is no safe drinking limit during pregnancy,” Chang said. And she says motivational counseling is “a smart solution and a great idea” to curb the cases of fetal alcohol syndrome. Up to two in every 1,000 babies born in the United States have the condition.
“Women are very smart, and if you actually talk to women about their drinking, they can put it all together and come up with the idea, that ‘gee, maybe this isn’t such a great thing to do,’” Chang said.
American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292.
Revision date: July 5, 2011
Last revised: by Sebastian Scheller, MD, ScD