Motivational counseling reduces risk for alcohol-exposed pregnancies

By Lorraine Cichowski, Mary Nettleman and Karen Ingersoll

RICHMOND, Va. – A multi-site, national pilot study that included participants at the Virginia Commonwealth University Medical Center suggests that motivational and contraception counseling reduces drinking and encourages effective contraception in women at risk for an alcohol-exposed pregnancy.

The results, reported in a supplement to the journal, Pediatrics, should help primary care physicians target early intervention and treatment for childbearing-age women, says Dr. Mary D. Nettleman, professor and chair of the Division of General Internal Medicine/Primary Care in VCU’s School of Medicine.

“Alcohol exposure during pregnancy is the leading non-genetic cause of mental retardation. Even moderate alcohol consumption can adversely affect the fetus,” said Nettleman, who was a primary investigator on the Project CHOICES motivational counseling study by the Centers for Disease Control, VCU, Nova Southeastern University and the University of Texas-Houston Health Science Center.

“Public health authorities have recommended for the past two decades that pregnant women abstain from alcohol. Still, alcohol use among pregnant women is rising and remains one of the leading preventable causes of birth defects and developmental disabilities. The results of this study should help primary care physicians intervene earlier when they identify childbearing women at risk and target new treatment options.”

Project CHOICES is a joint intervention program developed by the CDC and the three universities to identify high-risk women (such as those who use illicit drugs or have multiple male sex partners) before they become pregnant.  The program, which is now involved in an expanded, second phase of the research study on women’s health, is aimed at reducing risky drinking and postponing pregnancy until risk drinking is resolved.

The motivational counseling pilot study enrolled 190 women at six sites in Richmond; Fort Lauderdale, FL, and Houston, TX. About 60 of those women, who all were identified as being at risk for alcohol-exposed pregnancy, were at VCU. The study concluded that four sessions of motivational interviewing plus a contraception counseling session were successful in reducing risky drinking and increasing effective use of contraception.  Of those who completed a six-month follow-up, two-thirds no longer were at risk for an alcohol-exposed pregnancy.

In addition to Dr. Nettleman, a co-principal investigator on the study from VCU was Karen S. Ingersoll, Ph.D., assistant professor of psychiatry.