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

Abstract

Background: Prenatal alcohol exposure can result in a wide range of adverse health outcomes, including in some cases fetal alcohol spectrum disorder (FASD), a lifelong neurodevelopmental disorder. Thus, there is pressing need for effective interventions to prevent alcohol-exposed pregnancies (AEPs). Methods: A systematic review was undertaken to provide an up-to-date analysis of the current prevention literature. PubMed, Embase, CINAHL, and PsycINFO were searched for relevant English-language articles published from 1970 onward. Studies were eligible for the current systematic review if the interventions included pregnant and postpartum women and/or their support networks to prevent AEPs and FASD. Outcomes of interest included alcohol consumption, knowledge, contraceptive use, neonatal outcomes, family well-being or functioning, economics, and healthcare utilization outcomes. Results: Thirty-four peer-reviewed studies met the inclusion criteria. Fifteen studies employed brief intervention (BI) methods, 6 used long-term/intensive strategies, and 5 were educational interventions. A further 3 studies assessed counseling approaches, 2 evaluated multicomponent interventions, and 3 assessed nutritional supplementation interventions. Conclusions: The current review identified variable results from available interventions to prevent alcohol use among pregnant and postpartum women. Preliminary evidence demonstrated that BIs may be effective among subgroups of pregnant women with higher initial alcohol consumption, those with partner involvement, and those who used alcohol and other substances concurrently. Some preliminary evidence relating to long-term interventions with pregnant women with polysubstance use emerged, specifically case management that not only focused on reduction in substance use, but also on addressing the complex interplay between health and social well-being of families. Overall, additional research is required to improve the effectiveness of preventative approaches during pregnancy and the postpartum period.

Preconception interventions to reduce the risk of alcohol‐exposed pregnancies: A systematic review

“…The current review did not identify any interventions that included consideration of a woman's partner or wider social context (e.g., family members or friends) as a part of the intervention. This is also consistent with the recent review of pregnancy interventions (Erng et al, 2020), which also noted limited focus on wider contextual factors, which may maintain alcohol use and, in this case, may contribute to contraceptive decision making. For instance, Montag et al (2019) found that alcohol use in women of reproductive age within a Southern California American Indian community was strongly influenced by female friends and relatives.…”

“…Hand‐searching of reference lists yielded an additional 9 relevant studies, resulting in a total of 53 eligible studies. Of these, 19 focused on women who were not pregnant (the current review) and 34 focused on pregnant or postpartum women (Erng et al, 2020). No additional studies were identified from an updated search completed prior to submission.…”

“…The current review is part of a two‐part series (Erng et al, 2020) that aimed to summarize all the available evidence for interventions focused on prevention of AEPs. The aim was to collate the evidence for interventions specifically aimed at prevention of AEPs during the preconception period incorporating more recently published studies not included in previous reviews.…”

The Alcohol Industry and Social Responsibility: Links to FASD

“…Suggesting that the male drinking patterns also need to be addressed in relation to pregnancy is vital to successfully expanding the conversation on prevention. This would serve to move the issue from a "women's" issue to one that involves men and women [56] This expands the economic implications for the industry.…”

Effectiveness of Digital Interventions for Preventing Alcohol Consumption in Pregnancy: Systematic Review and Meta-analysis

“…By contrast, multiple systematic reviews and meta-analyses have examined the effectiveness of digital interventions for smoking cessation [ 13 - 15 ]. Only systematic reviews on the effectiveness of nondigital interventions for preventing alcohol consumption during pregnancy, such as cognitive-behavioral therapy and motivational interviewing [ 16 - 19 ], were found in our analyses. By contrast, a number of reviews examined the effectiveness of digital and computer-based alcohol intervention programs in primary care [ 20 , 21 ] or for patients recovering from substance use disorders [ 22 , 23 ], but such studies did not target pregnant women or women planning to become pregnant.…”