Reducing Prenatal Alcohol Exposure and the Incidence of FASD: Is the Past Prologue?

IF 6.8 1区 医学 Q1 SUBSTANCE ABUSE Alcohol Research : Current Reviews Pub Date : 2023-01-01 DOI:10.35946/arcr.v43.1.02
Grace Chang
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引用次数: 1

Abstract

Purpose: This narrative review summarizes and synthesizes the clinical trials and randomized clinical trials that evaluated selected and targeted approaches to reducing preconception and prenatal alcohol exposure (PAE) and alcohol-exposed pregnancy (AEP) since 2011.

Search methods: A professional hospital librarian completed the primary search using strategies specified within this review, resulting in 94 records returned in PubMed, Ovid MEDLINE, Clinical Key, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The author completed two supplementary literature searches.

Search results: From the total of 238 records returned from the three searches, 217 records were eliminated. Elimination reasons included other medical problem (119); duplicate entry (34); no content/results (23); secondary analysis (16); focus on effects of PAE (9); treatment of childhood fetal alcohol spectrum disorders (FASD) (6); maternal risk factors (3); and other (7). The remaining 21 studies were included with four overarching themes: (1) case management efforts (n = 4); (2) preconception efforts to reduce AEP (n = 5); (3) motivational interviewing and screening, brief intervention, and referral to treatment (n = 2); and (4) use of technology to deliver the intervention (n = 10).

Discussion and conclusions: Case management and home visits did not appear to have strong current empirical support. Study limitations included small sample sizes and no comparison groups, whereas larger efforts did not demonstrate definitive advantages to justify this intensive approach. The studies of preconception efforts, all based on the Project CHOICES approach, had similar outcomes, with the reduction in AEP risk largely due to improved contraception in women of childbearing age who were sexually active and drank alcohol but were not pregnant. It is unknown whether these women refrained from alcohol use when they became pregnant. Two studies of motivational interviewing to reduce prenatal alcohol use did not demonstrate the efficacy of the intervention. Both were small, with less than 200 pregnant women combined; moreover, the study samples had low baseline levels of alcohol use, allowing little opportunity for improvement. Finally, studies evaluating the impact of technological approaches to reducing AEP were reviewed. These exploratory investigations had small sample sizes and provided preliminary evaluations of techniques such as text messages, telephone contact, computer-based screening, and motivational interviewing. The potentially promising findings may inform future research and clinical efforts. Future directions may include research to address the limitations of the evidence to date and should reflect the complexities of FASD that include the biological and social context associated with prenatal alcohol use.

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减少产前酒精暴露和FASD的发生率:是过去的序幕吗?
目的:本综述总结和综合了自2011年以来评估减少孕前和产前酒精暴露(PAE)和酒精暴露妊娠(AEP)的选择性和针对性方法的临床试验和随机临床试验。检索方法:一位专业的医院图书管理员使用本综述中指定的策略完成了初步检索,在PubMed、Ovid MEDLINE、Clinical Key、世界卫生组织国际临床试验注册平台和ClinicalTrials.gov中检索到94条记录。作者完成了两次补充文献检索。搜索结果:从三个搜索返回的总计238条记录中,删除了217条记录。排除原因包括其他医疗问题(119);重复条目(34);无内容/结果(23);二次分析(16);关注PAE的作用(9);治疗儿童胎儿酒精谱系障碍(FASD) (6);产妇危险因素(3);其余21项研究包括四个总体主题:(1)病例管理工作(n = 4);(2)概念前努力降低AEP (n = 5);(3)动机性访谈与筛查、简短干预和转诊治疗(n = 2);(4)使用技术来提供干预(n = 10)。讨论和结论:病例管理和家访似乎没有强有力的实证支持。研究的局限性包括样本量小,没有对照组,而更大的努力并没有显示出明确的优势来证明这种强化方法的合理性。对孕前努力的研究,都基于项目选择方法,得出了类似的结果,AEP风险的降低主要是由于性活跃、饮酒但未怀孕的育龄妇女的避孕措施得到改善。目前尚不清楚这些妇女在怀孕后是否戒酒。两项旨在减少产前酒精使用的动机性访谈研究并未证明干预的有效性。这两家机构的规模都很小,总共不到200名孕妇;此外,研究样本的酒精使用基线水平较低,几乎没有改善的机会。最后,对评价技术途径对降低AEP影响的研究进行了综述。这些探索性调查样本量较小,并提供了诸如短信、电话联系、基于计算机的筛选和动机访谈等技术的初步评估。这些潜在的有希望的发现可能为未来的研究和临床工作提供信息。未来的方向可能包括研究,以解决迄今为止证据的局限性,并应反映FASD的复杂性,包括与产前酒精使用相关的生物学和社会背景。
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期刊介绍: Alcohol Research: Current Reviews (ARCR) is an open-access, peer-reviewed journal published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health. Starting from 2020, ARCR follows a continuous, rolling publication model, releasing one virtual issue per yearly volume. The journal offers free online access to its articles without subscription or pay-per-view fees. Readers can explore the content of the current volume, and past volumes are accessible in the journal's archive. ARCR's content, including previous titles, is indexed in PubMed, PsycINFO, Scopus, and Web of Science.
期刊最新文献
Low to Moderate Prenatal Alcohol Exposure and Neurodevelopmental Outcomes: A Narrative Review and Methodological Considerations. Reducing Prenatal Alcohol Exposure and the Incidence of FASD: Is the Past Prologue? Identifying Prenatal Alcohol Exposure and Children Affected by It: A Review of Biomarkers and Screening Tools. Simultaneous Alcohol and Marijuana Use Among Young Adults: A Scoping Review of Prevalence, Patterns, Psychosocial Correlates, and Consequences. Alcohol and the Adolescent Brain: What We've Learned and Where the Data Are Taking Us.
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