Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: A single-blinded, randomized controlled effectiveness trial

Abstract

Aims To assess the effect of brief motivational enhancement intervention postpartum alcohol use. Design Single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10–30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum. Setting Large, urban, obstetrics clinic. Participants Women who were ≥18 years old, < 20 weeks of gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n=165) or intervention (n=165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group. Measurements The proportion of women with any alcohol use and the number of drinks per day, reported via follow-up telephone interviews at 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks, 6 months, and 12 months postpartum. Findings In random effects models adjusted for confounders, the intervention group was less likely to use any alcohol (odds ratio 0.50; 95% confidence interval [CI], 0.23 – 1.09; P=0.08) and consumed fewer drinks per day (coefficient −0.11; 95% CI −0.23 − 0.01; P=0.07) than the usual care group in the postpartum period but these differences were non-significant. Missing data during the prenatal period prevented us from modeling prenatal alcohol use. Conclusions Brief motivational enhancement intervention delivered in an obstetrical outpatient setting did not conclusively decrease alcohol use during the postpartum period.

Prevention of Alcohol‐Exposed Pregnancies and Fetal Alcohol Spectrum Disorder Among Pregnant and Postpartum Women: A Systematic Review

“…For postpartum alcohol use, both single BI during the postpartum period (Ondersma et al, 2016) and 4 antenatal plus one postpartum motivational enhancement session (Rubio et al, 2014) did not show significant effects compared with the control groups receiving usual care. Additionally, studies on computer‐delivered BI, a relatively new mode of BI, were either feasibility and acceptability or pilot studies.…”

“…Overall, it is important to note that 3 of the 15 BI studies, which showed no significant treatment effects, were either feasibility or pilot studies. The majority of studies employing BI demonstrated reduced external validity scores on study quality assessment; specifically, blinding to treatment assignment was only demonstrated by 5 studies (Fleming et al, 2008; Ondersma et al, 2015, 2016; Rubio et al, 2014; Tzilos et al, 2011). Treatment fidelity was however demonstrated by the majority of studies (Armstrong et al, 2009; Chang et al, 1999; Handmaker et al, 1999; Marais et al, 2011).…”

A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use

“…For example, Fleming and colleagues evaluated a four-session series of postpartum motivational sessions, delivered during routine medical care, and found significant reductions in several drinking-related outcomes [10]. In contrast, Rubio and colleagues examined a five-session, primarily during-pregnancy motivational intervention and found small but not significant effects on postpartum alcohol use [11]. Such findings should be considered in light of the much larger literature using general samples of adults with unhealthy alcohol use.…”

Brief Intervention for Risky Alcohol Use: A Critical Analysis

“…Although very limited in number and methodological quality, there is some evidence on brief intervention for heavy drinkings such as psychiatric outpatient setting, [45] community-based counselling centres, sexual health clinics, and antenatal care and postpartum care settings [46][47][48][49]. However, none of the studies reported a superior benefit for brief intervention as compared to routine care [50,51].…”