Motivational intervention to reduce alcohol-exposed pregnancies--Florida, Texas, and Virginia, 1997-2001

Prenatal alcohol use is a threat to healthy pregnancy outcomes for many U.S. women. During 1999, approximately 500,000 pregnant women reported having one or more drinks during the preceding month, and approximately 130,000 reported having seven or more alcohol drinks per week or engaging in binge drinking (i.e., five or more drinks in a day). These heavier drinking patterns have been associated with fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorders (ARND). Lower levels of alcohol consumption (i.e., fewer than seven drinks per week) also have been associated with measurable effects on children's development and behavior. Although the majority of women reduce their alcohol use substantially when they realize they are pregnant, a large proportion do not realize they are pregnant until well into the first trimester and, therefore, might continue to drink alcohol during this critical period of fetal development. To reduce alcohol-exposed pregnancies, CDC initiated a multisite pilot study (phase I clinical trial) in 1997 to investigate the use of a dual intervention focused on both alcohol-use reduction and effective contraception among childbearing-aged women at high risk for an alcohol-exposed pregnancy (Project CHOICES). This report describes the association between baseline drinking measures and the success women have achieved in reducing their risk for an alcohol-exposed pregnancy. The analysis compares the impact of the motivational intervention at 6-month follow-up on women drinking at high-, medium-, and low-risk drinking levels. The findings indicate that although 69% of the women in the study reduced their risk for an alcohol-exposed pregnancy, women with the lowest baseline drinking measures achieved the highest rates of outcome success, primarily by choosing effective contraception and, secondarily, by reducing alcohol use. Women with higher baseline drinking measures chose both approaches equally but achieved lower success rates for reducing their risk for an alcohol-exposed pregnancy. A randomized controlled trial of the motivational intervention is under way to further investigate outcomes of the phase I study.