Primary prevention

A broad-based approach, from population-wide programmes to targeted measures for high-risk individuals, is required for the prevention of fetal alcohol spectrum disorder (FASD).[22] The causal pathway to FASD involves complex interactions between a variety of social, political, environmental, and genetic risk factors. There are multiple points along the pathway where preventive measures can be instituted, from the community level to the individual.[23]

Population-based strategies include the development of national guidelines regarding alcohol consumption in pregnancy; community education programmes and public health campaigns; improved health, housing, and community services; and legislative measures. Legislation may include taxation or minimum unit pricing of alcohol warning labels about alcohol harms in pregnancy on alcoholic beverages, mandatory warnings in licensed premises about the dangers of alcohol in pregnancy, and legislation banning the sale of alcohol and beverages with high alcohol content to the community, totally 'dry communities', and restrictions on advertising and promotion. Legislative measures vary within and between countries. Centers for Disease Control and Prevention: fetal alcohol spectrum disorders (FASDs) Opens in new window Many countries recommend that abstinence from alcohol is the safest choice for women who are pregnant, are planning a pregnancy, or could become pregnant.[24][25][26]

A systematic review of psychological and educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy reported that educational and counselling interventions may encourage pregnant women to reduce or stop alcohol consumption.[27] Prevention programmes in indigenous communities, in which high rates of alcohol use are common, must be culturally sensitive, evidence-based, and developed in collaboration with community members. Few have been rigorously evaluated, which is a priority for the future.[28]

Brief intervention and motivational interviewing are approaches that may be used to reduce alcohol consumption by pregnant women.[29] Brief intervention involves identification of alcohol consumption, assessment of the level of risk, informing the woman of the consequences of alcohol consumption in pregnancy, and using a method that promotes and monitors behaviour change. Brief intervention should include review of:

  • General health

  • Pregnancy progress

  • Lifestyle changes since conception

  • Level of motivation to change drinking behaviour

  • Goal setting

  • Situations where the woman is most likely to drink.

Motivational interviewing is a technique that can be used as a brief intervention. It is intended to increase a woman's readiness to change by helping her resolve ambivalence about behaviour change. Key skills used in motivational interviewing are:[30]

  • Open-ended questioning

  • Affirmation

  • Eliciting discussion about behaviour change

  • Summarising

  • Reflective listening.

There is randomised controlled trial evidence that multiple sessions of motivational interviewing are more effective in reducing the number of drinks in a drinking day, ineffective contraception use, and risk of alcohol exposure in pregnancy at 6 months after the intervention (217 women at risk of alcohol use in pregnancy). Effect size is greater following multiple rather than single sessions.[31] Brief interventions by telephone are as effective as in-person interviews and may be a more cost-effective option.[32]

Secondary prevention

Mothers of children with FASD should be educated about the relationship between alcohol intake during pregnancy and FASD, and referred for drug and alcohol counselling and treatment in an attempt to prevent future babies being similarly affected. Half of children diagnosed with FAS have an affected sibling, indicating missed opportunities for prevention.[41] There is no evidence regarding the effectiveness of pharmacological or psychosocial interventions for pregnant women enrolled in alcohol treatment programmes.[94][95]​ In addition, there is no evidence regarding the effectiveness of antenatal or postnatal home visiting programmes for women with an alcohol problem in reducing fetal alcohol exposure or improving maternal or child outcomes.[96]

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