Psychosocial Interventions for Preventing Alcohol Use During Pregnancy

Universal Screening and Intervention Framework

The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women and women of childbearing age undergo universal screening for alcohol use, as no safe threshold of alcohol consumption during pregnancy has been established 1, 2, 3, 4
The American College of Obstetricians and Gynecologists (ACOG) suggests using the TWEAK or T-ACE screening instruments for pregnant women, which are designed to detect lower levels of alcohol consumption that may pose risks during pregnancy 6
The World Health Organization (WHO) recommends assessing quantity, frequency, heavy episodic drinking, and behavioral manifestations of risk drinking 1, 2

Brief multicomponent interventions, such as those using the FRAMES framework, are effective in reducing alcohol consumption and increasing abstinence rates in pregnant women 1, 2, 4
The FRAMES model includes feedback of personal risk, responsibility for personal control, advice to change, menu of ways to reduce or stop drinking, empathetic counseling style, and self-efficacy or optimism regarding reducing or stopping drinking 1, 2, 4
The 5 A's behavioral counseling framework, which includes assess, advise, agree, assist, and arrange, is also an effective approach for primary care interventions 7, 6

Interventions can be delivered by physician and nonphysician practitioners as part of the healthcare team, and require brief provider training or access to specially trained practitioners or health educators 7, 6
Office-level systems supports, including prompts, reminders, counseling algorithms, and patient education materials, are also necessary for effective implementation 7, 6

The CDC and the US Preventive Services Task Force (USPSTF) recommend that all pregnant women be advised to abstain completely from alcohol, as safe levels of consumption during pregnancy are not known 1, 3, 4, 7, 8, 6
The American Academy of Pediatrics (AAP) also recommends that pregnant women abstain from alcohol, and that women who are breastfeeding should also avoid alcohol consumption 1, 3