23.3% of women attending prenatal care in Brazzaville reported alcohol use during pregnancy and 83% of them continued to drink after recognition of pregnancy. Prenatal alcohol exposure should be the focus of efforts to improve identification of alcohol use prior to and during pregnancy to improve maternal and child health. Birth Defects Research (Part A) 97:489-496, 2013. © 2013 Wiley Periodicals, Inc.

Objective: Determine the effectiveness of an intervention to reduce prenatal alcohol exposure in the Congo. Methods: We utilized a screening tool validated in the Congo to identify women who were drinking during pregnancy. The intervention was implemented by prenatal care providers comparing 162 women receiving the intervention with 58 (controls) who did not. The study endpoints were proportion of women who quit drinking, drinking days per week, drinks per drinking day, most drinks on any day, and number of binge episodes per week. Results: In the control group 36% of the women quit drinking compared to 54% in the intervention group (Chi-square 5.61; p = 0.02). The number of drinking days per week for the controls decreased by 50.1% compared to 68% for the intervention group (p = 0.008); drinks per drinking day for the controls decreased by 37% compared to 60.1% for the intervention group (p = 0.001); and most drinks on any occasion in the controls decreased by 38% compared to 61% for the intervention group (p = 0.004). Conclusions: This study demonstrates the effectiveness of a low cost in-office intervention to reduce prenatal alcohol exposure in the Congo. At $1.50 per beer, the reduction in drinks per week would more than pay for the cost of the intervention. In addition to efforts to reduce alcohol use prior to pregnancy in the Congo, providers can now offer an evidence based intervention to reduce exposure for women who continue to drink during pregnancy.

Aims: Development of useful estimates of rates of maternal smoking during pregnancy, and the impact of smoking on rates and duration of maternal alcohol use during pregnancy.Design: A prospective study utilizing systematic screening of consecutive pregnant women. Setting:Ten prenatal care sites in Brazzaville, Congo's largest city, where 50% of live births in the Congo occur. Women were asked to report the number of cigarettes smoked per day. Findings:From the 10 sites, 3,099 women were screened and 5.5% (n = 172) reported smoking. The mean number of cigarettes smoked per day was 1.1 and only 11% (n = 19) of the women reported smoking two or more cigarettes per day during pregnancy. Smoking during pregnancy was associated with a 4.9-fold increase in prenatal alcohol exposure during pregnancy. We found that 93% of the women who smoked also used alcohol during pregnancy. Conclusions:While the prevalence of smoking and the average number of cigarettes smoked per day were both low, smoking at any level results in a huge increase in risk for maternal alcohol use during pregnancy. The trend across the developing world is for increasing rates of smoking among women and children. Since the number of cigarettes smoked per day was low, smoking cessation programs and public health warnings may be useful in further reducing rates of smoking during pregnancy and, thus, risk for prenatal alcohol exposure in the Congo. We believe this is the first report quantifying the risk of smoking and prenatal alcohol use in a population of pregnant women.

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