Abstract
In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD.
Highlights
Abstinence from alcohol during pregnancy is an important and theoretically attainable goal with known benefits for the unborn child
The analyses reported in this paper provide an update and further analysis of the drinking data previously reported, which serve as a meaningful backdrop for better understanding the association between drinking and happiness while in Case management (CM)
It is likely that many women drank less between their screening visit and their baseline visit initiating the start of CM when weekly drinking was first assessed
Summary
Abstinence from alcohol during pregnancy is an important and theoretically attainable goal with known benefits for the unborn child. The prevalence of FASD in the Western Cape Province of ZA is the highest documented in the world (136 to 209 per 1000 children or 13.6% to 20.9%) [7] In this region, a subculture of binge drinking makes it common for up to 40% of women of childbearing age to drink two to nine alcoholic beverages each Friday and Saturday night [8,9,10,11]. Universal methods focus on public education and policy aimed at the entire population, selected prevention targets women of childbearing age with a focus on avoiding alcohol before and during pregnancy, and indicated prevention is a tertiary level approach for women who are already pregnant and drink large amounts of alcohol [2]. The analyses reported in this paper provide an update and further analysis of the drinking data previously reported, which serve as a meaningful backdrop for better understanding the association between drinking and happiness while in CM
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