摘要：Objectives. We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. Methods. Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed. Results. Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. Conclusions. The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies. The prevalence of alcohol use among pregnant women is more than 12%, which suggests that approximately 1 in 8 fetuses is exposed to alcohol in utero. 1 Moreover, it is estimated that about 1 in 100 children has a fetal alcohol spectrum disorder, which is associated with substantial life-long impairments in neurocognitive and socioemotional development. 2 Even low levels of alcohol consumption have been shown to be related to negative developmental sequelae. 3 – 7 Furthermore, children from low-income ethnic minority populations are particularly vulnerable to the long-term effects of prenatal alcohol exposure, because their mothers are less likely to receive appropriate counseling regarding alcohol use during pregnancy. 8 , 9 For these reasons, effective prevention of alcohol use by pregnant women has become an important national priority. 10 Derived from the principles of social learning theory, brief intervention is an effective methodology that has been empirically validated in a number of alcohol-related studies. 11 – 14 The approach uses 10-to 15-minute sessions of counseling that can be delivered by personnel who are not specialists in the treatment of alcohol abuse or dependence. Most successful brief interventions include (1) feedback aimed at increasing awareness of the negative consequences of drinking, (2) advice focused on identifying risky situations and actions aimed at reducing consumption, and (3) assistance with formulating drinking reduction goals. 11 – 14 Brief intervention has been shown to be a low-cost, effective treatment alternative for alcohol use problems. The methodology uses time-limited, self-help strategies to promote reductions in alcohol use in nondependent individuals, and in the case of dependent persons, to facilitate referral to specialized treatment programs. 15 – 17 In spite of the proven effectiveness of brief intervention in the general population, there have been few controlled studies on the use of this technique for counseling pregnant women. Three studies have been published to date, and in all of these studies, the interventions were integrated into obstetric care in primary care settings where advice was typically provided by physicians. 18 – 21 With the exception of a small pilot study that used motivational interviewing, 22 and another study 18 that used a manual approach, intervention has typically concentrated on middle-class, White, non-Hispanic women. Given the focus of most research on nonminority, middle-class women seen in obstetric clinics, the purpose of our study was to examine the effectiveness of brief intervention in helping low-income minority women achieve abstinence from alcohol during pregnancy, in an accessible community-based setting, and by using nonmedical providers (nutritionists from the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children; PHFE-WIC). Gestational age, neonatal weight and length, and fetal viability served as outcome variables for evaluating the efficacy of brief intervention. 23 – 26
