A Systematic Review and Meta-Analysis of the Effectiveness of Brief Interventions for Reducing Antenatal Alcohol Consumption

Abstract

Antenatal alcohol consumption increases risk of adverse pregnancy outcomes. It is recommended that pregnant women abstain from alcohol, though 14.5% of pregnant Australians are reported not to. Screening and brief interventions, which involve single, short therapeutic sessions to motivate behaviour change, are recommended for treatment of antenatal alcohol consumption. However, limited evidentiary support for the practice, reports of poor clinical applicability, and the lack of existing meta-analyses of patterns of use data raise concerns about whether these recommendations are justified. This meta-analysis investigates the effectiveness of ≤60-minute single-session brief interventions on reducing alcohol consumption frequency, quantity, and abstinence outcomes in pregnant women screened positive for alcohol use. Seven databases were searched to yield 15716 records. Nine studies were included for review, and eight for analysis. Exclusions were made for polydrug and multi-session screening or interventions. Frequency and quantity outcomes were assessed using Hedges’ g values and abstinence outcomes using odds ratios. Subgroup analyses and meta-regressions were conducted on potential predictors of effectiveness. Random-effects models were employed. Significant effects in favour of intervention were observed only for meta-analyses of abstinence outcomes. However, no results were deemed clinically significant due to the limited number of studies viable for analysis and their notable risks of bias. Imprecision and high risk of publication biases were also identified. Existing healthcare recommendations were therefore not validated and a need for further research with more consistent methodologies was identified. How research consistently, quality, and ethicality could be improved in future studies is discussed, with a framework provided.