Key messages
We found that among pregnant women who report alcohol use during pregnancy, brief psychosocial interventions (BIs) may increase the number of continuously abstinent women when compared to treatment as usual (TAU). There may be no difference between groups in the number of drinks per day, but the evidence is very uncertain. Receiving a BI compared to TAU probably results in little to no difference in the number of women who completed treatment.
What are the consequences of alcohol use during pregnancy?
Alcohol use during pregnancy can have severe consequences for both the pregnant woman and the embryo and fetus. Higher amounts of alcohol are associated with the greatest risk; however, low-to-moderate prenatal alcohol exposure is also linked to certain deficits at birth. Accordingly, any alcohol use confers some risk during pregnancy, and current guidelines recommend avoiding alcohol use during pregnancy. Nevertheless, in Europe, approximately one out of four pregnant women report alcohol use during pregnancy.
Which treatments are available to stop or reduce alcohol use during pregnancy?
Psychosocial interventions and medications have been shown to be effective for unhealthy alcohol use within the general population. Those with alcohol use disorder (AUD), a mental disorder where the person is unable to control their alcohol use, may additionally benefit from medications. It is unclear if these treatments are effective among pregnant women who report alcohol use during pregnancy.
What did we want to find out?
We wanted to find out whether psychosocial interventions or medications can help pregnant women who report alcohol use in reducing or stopping such behaviour.
What did we do?
We searched for randomised controlled trials (studies in which participants are randomly assigned to one of two or more treatment groups) that compared psychosocial interventions or medications, or both, with no treatment, TAU, placebo (dummy treatment), or other treatments to help pregnant women stop or reduce their alcohol use.
What did we find?
We included eight studies involving a total of 1369 pregnant women who reported alcohol use during pregnancy. In two studies, almost half of the participants were diagnosed with current or previous AUD. Most studies (75%) took place in the USA. Treatments were BIs, ranging from 10 to 60 minutes in duration, mainly delivered in a single session or few sessions (up to five). The group receiving BIs was compared with a group receiving TAU. Pregnant women received the psychosocial intervention at approximately 15 weeks of pregnancy, and alcohol use was assessed 8 to 24 weeks after the intervention. We did not find any study that looked at the effects of AUD medications during pregnancy.
We found that BIs may increase the rate of continuously abstinent women. The evidence is very uncertain about the effect of BIs on the number of drinks per day. Finally, we found that BIs probably result in little to no difference in the number of women who completed treatment.
What are the limitations of the evidence?
We did not find any study that assessed the effectiveness and safety of AUD medications during pregnancy. Only two studies recruited pregnant women with current or lifetime AUD; this limitation means we cannot generalise our results to pregnant women who have AUD. Further studies are needed to evaluate the effects of psychosocial interventions or medication in helping pregnant women with AUD to stop or reduce alcohol use.
The effects of psychosocial interventions are largely influenced by the social context; given that most of the included studies took place in the USA, this limits the generalisability of the findings to countries and marginalised ethnic groups not recruited to these studies.
Globally, our results are far from being considered conclusive.
How up-to-date is this evidence?
The evidence is current to 8 January 2024.
Brief psychosocial interventions may increase the rate of continuous abstinence among pregnant women who report alcohol use during pregnancy. Further studies should be conducted to investigate the efficacy and safety of psychosocial interventions and other treatments (e.g. medications) for women with AUD. These studies should provide detailed information on alcohol use before and during pregnancy using consistent measures such as the number of drinks per drinking day. When heterogeneous populations are recruited, more detailed information on alcohol use during pregnancy should be provided to allow future systematic reviews to be conducted. Other important information that would enhance the usefulness of these studies would be the presence of other comorbid conditions such as anxiety, mood disorders, and the use of other psychoactive substances.
Despite the known harms, alcohol consumption is common in pregnancy. Rates vary between countries, and are estimated to be 10% globally, with up to 25% in Europe.
To assess the efficacy of psychosocial interventions and medications to reduce or stop alcohol consumption during pregnancy.
We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO, from inception to 8 January 2024. We also searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). All searches included non-English language literature. We handsearched references of topic-related systematic reviews and included studies.
We included randomised controlled trials that compared medications or psychosocial interventions, or both, to placebo, no intervention, usual care, or other medications or psychosocial interventions used to reduce or stop alcohol use during pregnancy. Our primary outcomes of interest were abstinence from alcohol, reduction in alcohol consumption, retention in treatment, and women with any adverse event.
We used standard Cochrane methodological procedures.
We included eight studies (1369 participants) in which pregnant women received an intervention to stop or reduce alcohol use during pregnancy. In one study, almost half of participants had a current diagnosis of alcohol use disorder (AUD); in another study, 40% of participants had a lifetime diagnosis of AUD. Six studies took place in the USA, one in Spain, and one in the Netherlands.
All included studies evaluated the efficacy of psychosocial interventions; we did not find any study that evaluated the efficacy of medications for the treatment of AUD during pregnancy. Psychosocial interventions were mainly brief interventions ranging from a single session of 10 to 60 minutes to five sessions of 10 minutes each. Pregnant women received the psychosocial intervention approximately at the end of the first trimester of pregnancy, and the outcome of alcohol use was reassessed 8 to 24 weeks after the psychosocial intervention. Women in the control group received treatment as usual (TAU) or similar treatments such as comprehensive assessment of alcohol use and advice to stop drinking during pregnancy.
Globally, we found that, compared to TAU, psychosocial interventions may increase the rate of continuously abstinent participants (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.14 to 1.57; I2 =0%; 3 studies; 378 women; low certainty evidence). Psychosocial interventions may have little to no effect on the number of drinks per day, but the evidence is very uncertain (mean difference −0.42, 95% CI −1.13 to 0.28; I2 = 86%; 2 studies; 157 women; very low certainty evidence). Psychosocial interventions probably have little to no effect on the number of women who completed treatment (RR 0.98, 95% CI 0.94 to 1.02; I2 = 0%; 7 studies; 1283 women; moderate certainty evidence). None of the included studies assessed adverse events of treatments.
We downgraded the certainty of the evidence due to risk of bias and imprecision of the estimates.