A randomized controlled trial of motivational interviewing to prevent risk for an alcohol‐exposed pregnancy in the Western Cape, South Africa

Abstract

AimTo test the effectiveness of motivational interviewing (MI) to reduce the risk of an alcohol exposed pregnancy (AEP) in a high-risk population.Design Randomized controlled trial.Setting Rural population in the Western Cape, South Africa.Participants A total of 165 women aged 18-44 years at risk of AEP.Intervention Five-session MI intervention.Measurements Structured questionnaires were administered pre-intervention and at 3 and 12 months follow-up. The primary outcome measure was AEP at 12 months. Secondary outcomes were AEP at 3 months, and alcohol use and effective contraception at 3 and 12 months.Findings There was a significant difference in the decline in the proportion of women at risk for an AEP in the MI group at 3 months (50 versus 24.59%; P = 0.004), maintained at 12 months (50.82 versus 28.12%; P = 0.009). In an intention-to-treat analysis these differences were also significant (32.93 versus 18.07%; P = 0.029; and 37.80 versus 21.69%; P = 0.024, respectively). The odds ratio for no longer being at risk of an AEP (MI versus control) at 12 months was 2.64 [95% confidence interval (CI): 1.18-5.94]. In the intention-to-treat analysis this ratio was 2.19 (95% CI: 1.05-4.65).Conclusions A five-session motivational interviewing intervention was found to be effective with women at risk of an alcohol-exposed pregnancy, and could be implemented as part of routine primary care clinic services in similar populations. The message of 'no alcohol in pregnancy' should be adapted to include better family planning and early recognition of pregnancy.

Should drinking during pregnancy be criminalised to prevent fetal alcohol spectrum disorder?

“…[1][2][3][4][5][6] Drinking during pregnancy has been correlated with negative pregnancy outcomes including an increase in spontaneous abortion, fetal growth retardation, premature delivery, abruptio placentae and breech presentations. [7] During the first trimester, alcohol can change the way in which cells grow and organise them selves and result in abnormalities of the face, heart, brain, limbs and urogenital system.…”

“…[7] During the first trimester, alcohol can change the way in which cells grow and organise them selves and result in abnormalities of the face, heart, brain, limbs and urogenital system. [3] In the second trimester, it can lead to miscarriage, and in the third trimester, it can impair overall fetal growth. [3] Because the brain continues to grow throughout pregnancy and postpartum, it is most sensitive to alcohol's damaging effects.…”

“…[3] In the second trimester, it can lead to miscarriage, and in the third trimester, it can impair overall fetal growth. [3] Because the brain continues to grow throughout pregnancy and postpartum, it is most sensitive to alcohol's damaging effects.…”

Preventing Alcohol Consumption during Pregnancy: A Randomized Controlled Trial

“…Women can be screened and offered to participate in an intervention when seeking emergency contraception or taking pregnancy tests at maternity clinics [21]. Improving effective contraception use among sexually active women in childbearing age is a further measure for preventing alcohol-exposed pregnancies [22] [23]. Different countries have different conditions in terms of health care settings and existing routines, and intervention-studies utilize those conditions in different ways.…”

“…A commonly used method for preventing alcohol-exposed pregnancies is motivational interviewing (MI) [24], a method that has been tested and evaluated [22] [25] [26]. MI interventions usually consist of several counseling sessions.…”