Effectiveness of brief alcohol interventions for pregnant women: A systematic literature review and meta-analysis

Prenatal alcohol exposure (PAE) can result in a range of adverse neonatal outcomes, including Fetal Alcohol Spectrum Disorder (FASD). This systematic review and meta-analysis sought to investigate the effectiveness of brief interventions (BIs) in eliminating or reducing 1) alcohol consumption during pregnancy; and 2) PAE-related adverse neonatal outcomes.

We conducted a systematic literature search for original controlled studies (randomized control trials (RCTs); quasi-experimental) in any setting, published from 1987 to 2021. The comparison group was no/minimal intervention, where a measure of alcohol consumption was reported. Studies were critically appraised using the Centre for Evidence-based Medicine Oxford critical appraisal tool for RCTs. Metaanalysis of continuous and binary estimates of effect-size for similar outcome measures for BIs versus control groups were pooled and reported as Cohens’ d/ Hedge’s g and odds ratios (ORs), respectively.

In total, 22 studies (4,865 participants), all from high income countries, met inclusion criteria. Abstinence outcomes available in 12 studies (n= 2,620) found modest effects in favor of BI conditions (OR=1.56, 95% CI=1.15–2.13, I 2=46.75%). BI effects for mean drinks/week (Cohen’s d=- 0.21, 95%CI=- 0.78 to 0.36) and AUDIT scores (g = 0.10, 95%CI= – 0.06 to 0.26) were not significant. Among seven studies (n = 740) reporting neonatal outcomes, BI receipt was associated with a modest and significant reduction in preterm birth (OR=0.67, 95% CI=0.46-0.98, I 2=0.00%). No statistically significant differences were observed for APGAR score, mean birthweight, or likelihood of low birth weight (LBW).

BIs are moderately effective in increasing abstinence during pregnancy and preventing preterm birth. More studies on the effectiveness of BIs are needed from low- and middle-income countries, as well as with younger mothers and with a broader range of ethnic groups. There is also an urgent need for systematic research seeking to enhance the efficacy of brief interventions.

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