Psychosocial Interventions to Reduce Alcohol Use During Pregnancy

Are psychosocial interventions effective for reducing alcohol use during pregnancy?

Psychosocial interventions may increase the rate of sustained alcohol cessation during pregnancy (number needed to treat [NNT] for one more patient to stay continuously abstinent for 2–6 months = 6; 95% CI, 4–15).¹ However, they may have little to no effect on the number of drinks consumed per day or treatment retention. (Strength of Recommendation: C, disease-oriented evidence.)

Prenatal alcohol use causes dose-dependent negative health effects for the pregnant person as well as the developing embryo or fetus.¹ Risks include early pregnancy loss, fetal demise, fetal growth restriction, placental abruption, preterm labor, and premature birth. Alcohol consumption is the leading cause of preventable developmental disability and structural congenital anomalies in the United States.^1,2 Despite the known risks, prenatal alcohol use is common, and its prevalence in the United States has increased in recent years.³ Per 2018–2020 national surveillance data, approximately 1 in 7 pregnant people reported any alcohol use, and 1 in 20 reported binge drinking (ie, four or more drinks on a single occasion) within the past month.³ The authors of this Cochrane review sought to investigate the effectiveness of prenatal interventions (psychosocial or pharmacologic) to reduce or stop alcohol use during pregnancy.

The authors identified eight randomized controlled trials (N = 1,369).¹ Participants were pregnant people who reported current prenatal alcohol use. Two studies included people with current or a lifetime history of alcohol use disorder. All included studies evaluated psychosocial interventions; no studies evaluating medications were identified. Psychosocial interventions comprised brief interventions, motivational interviewing, self-help programs, brief motivational enhancements, or computer-delivered health counseling and were administered on average at 15 weeks' gestation (range = 7–25 weeks) with durations of 10 to 60 minutes each over 1 to 5 sessions. All were compared with treatment as usual. Assessment of alcohol use outcomes was performed between 2 and 6 months postintervention.

Based on the available data, psychosocial interventions may increase continuous abstinence from alcohol among pregnant people at 2 to 6 months postintervention (risk ratio [RR] = 1.34; 95% CI, 1.14–1.57; three studies; 378 participants; low-certainty evidence; NNT to have one more person stay continuously abstinent = 6 [95% CI, 4–15]). This effect was driven by the results of three studies in which the intervention consisted of a single session of motivational interviewing, one-time provision of a self-help manual, or three-part computer-based health counseling. Psychosocial interventions were not shown to significantly affect the number of drinks per day or retention in treatment (ie, completion of study interventions). All studies had a high risk of bias. Adverse effects were not reported.

The US Preventive Services Task Force recommends screening and brief behavioral interventions for any alcohol use during pregnancy,⁴ which is consistent with recommendations from other major national medical organizations.^5–7 There are limited data specific to pregnancy regarding psychosocial interventions for alcohol use, although this review suggests that such interventions can improve rates of sustained alcohol cessation.¹ The longitudinal nature of prenatal and primary care provides unique opportunities for serial screening and brief interventions similar to the protocols of the studies included within this review. Future investigations of psychosocial and pharmacologic interventions for pregnant patients who consume alcohol could expand treatment options for this vulnerable and often understudied population.