How research on drinking during pregnancy should inform social work practice

Latest research findings

A recent UK survey found that while 33% of pregnant women reported stopping drinking during pregnancy and 63% cut down their intake, 8% said they exceeded medically recommended guidelines for low-risk drinking in pregnancy. Therefore, of the 650,000 registered births per year in England and Wales, approximately 52,000 children may have been significantly exposed to alcohol.

The teratogenic effects (relating to, or causing, malformations of an embryo or foetus) of heavy alcohol consumption are well known and experts agree there is a dose-dependent effect of alcohol on foetal and child development, so reducing prenatal exposure to alcohol is important. Furthermore, pregnancy is believed to offer a ‘teachable moment’ where interventions may evoke change. The evidence base for interventions with this group is somewhat limited, however.

Chang (2005) conducted a study of brief interventions (25-minute alcohol interventions), which found improved drinking outcomes for heavier-drinking women who received the intervention when compared to a control group. Women receiving the brief intervention were also more likely to be abstinent at follow-up appointments.

Multi-session brief interventions with women reporting alcohol use during pregnancy have also been found to have positive effects (O’Connor and Whaley, 2007). Within this study, women received an initial single session and further intervention at each attendance at antenatal care if alcohol use continued. Participants were five times more likely to be abstinent in the third trimester than those in the control group. Positive neonatal outcomes were also identified.

Handmaker et al (1999) conducted a study of single-session motivational interviewing (one-hour duration) with pregnant women. This higher-intensity intervention was effective in reducing alcohol use in women who consumed higher levels of alcohol.

The impact on practice

There is some evidence from high-quality trials that single-session brief intervention can reduce alcohol use in pregnant women. Furthermore, these trials found that such interventions increase the likelihood of women maintaining abstinence during pregnancy. Women who continue to drink alcohol or who consume greater amounts of alcohol may require more intensive interventions at multiple points.

Social workers should routinely discuss alcohol use with pregnant women. Social workers should provide brief interventions to women who report drinking alcohol during pregnancy and regularly review alcohol use to identified continued use. Women who continue to drink alcohol should be provided with further intervention at an intensity to match their need.

Pregnancy offers a ‘window of opportunity’ to intervene with women who drink alcohol at risky levels. Social workers and health care providers are well placed to intervene with pregnant women in order to reduce the risk of harm on the developing foetus and child.

Questions for practice

• Can social workers achieve the necessary balance between care and control in order to provide the optimum relationship to intervene with pregnant women who drink alcohol?
• With significant disagreement over what is a ‘safe’ level of alcohol consumption in pregnancy, when does alcohol use become a safeguarding issue?
• Current research evidence comes from the USA. Is the evidence transferable to the UK, which has significant cultural, antenatal and social care differences?

References and further reading

Inform subscribers: Social work guide to Fetal Alcohol Spectrum Disorders, by Dr Raja Mukherjee, consultant psychiatrist, Surrey Borders Partnership Trust, Bracketts Resource Centre

Bolling, K., Grant, C., Hamlyn, B., and Thornton, A., ‘Infant Feeding Survey 2005’, Department of Health, 2007

Chang, G., McNamara, T.K., Orav, E.J., Koby, D., Lavigne, A., Ludman, B., et al (2005), ‘Brief intervention for prenatal alcohol use: a randomized trial’, Obstetrics & Gynecology 105:5, p991-998

Handmaker, N.S., Miller, W.R., and Manicke, M. (1999), ‘Findings of a pilot study of motivational interviewing with pregnant drinkers’, Journal of Studies on Alcohol, 60:2, p285-287

O’Connor, M.J., and Whaley, S.E. (2007), ‘Brief intervention for alcohol use by pregnant women’, American Journal of Public Health, 97:2, p252-258

Patra, J., Bakker, R., Irving, H., Jaddoe, V.W.V., Malini, S., and Rehm, J. (2011), ‘Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA) – a systematic review and meta-analyses’, BJOG: An International Journal of Obstetrics and Gynaecology, 118:12, p1411-1421