PRENATAL COUNSELING

Are efforts to reduce alcohol use among gravidas successful?

Floyd RL, Sobell M, Velasquez M, et al; Project CHOICES Efficacy Study Group. Preventing alcohol-exposed pregnancies. A randomized controlled trial. Am J Prev Med. 2007;32:1–10.

Brief intervention has been a successful tool for changing the behavior of nonpregnant adults. It also appears to be effective and efficient in the pregnant population. A brief intervention typically consists of a time-limited motivational counseling session that aims to educate, recommend a change in habits, and help the patient set goals. Brief intervention has had special success among nondependent women and has been used effectively in obstetric clinics and among women of various racial, ethnic, and socioeconomic backgrounds.

This randomized, controlled trial by Floyd and colleagues focused on the pregnant population. Like three other brief intervention trials conducted between 2000 and 2006, it found that brief intervention reduced alcohol consumption, increased positive newborn outcomes, and decreased alcohol consumption in subsequent pregnancies.^3-5

FRAMES model: 6 manageable steps

One successful brief intervention is the FRAMES model, which is included in the ACOG tool kit for physicians. It is based on concepts of:

• feedback (F) – compare the patient’s level of drinking with drinking patterns that are not risky
  
• responsibility (R) – emphasize that it is up to her to change her habits
  
• advice (A) – counsel her to change her behavior
  
• menu (M) – identify risky drinking situations and offer tactics for coping
  
• empathy (E) – be understanding
  
• self-efficacy (S) – encourage the patient to set goals and commit to change.
  

Use an individualized approach to change behavior

Despite widespread, population-based educational efforts throughout the 1990s, the prevalence of alcohol consumption among nonpregnant and pregnant women remains largely unchanged or even increased, particularly binge drinking. Other approaches are needed to avert the largest preventable contributor to birth defects and childhood neurodevelopmental disability.

With improved and validated office-based methods for identifying alcohol consumption, along with referrals when appropriate, it is possible to reduce maternal alcohol consumption during pregnancy. These simple methods are also easy to incorporate into an office routine. Equally important is incorporation of these methods into the office visit for the nonpregnant woman of reproductive age, with the aim of reducing alcohol consumption and increasing use of effective contraception.