To determine whether the postpartum period is an effective time to counsel women about alcohol use, researchers screened 8706 women at their 45-day postpartum visit and randomized 235 women who met inclusion criteria* to either usual care (receipt of a booklet on general health issues but no specific counseling) or brief intervention (BI). The intervention consisted of two 15-minute counseling visits with a nurse or obstetrician, each 1 month apart, and a follow-up phone call 2 weeks after each visit. Past 28-day alcohol use was assessed at baseline and by phone interview at 6 months.

• Twenty-three of 122 women (19%) in the BI group did not receive an intervention because they failed to show up for scheduled counseling visits.
• An additional 23 women (19%) in the intervention group and 5 women (4%) in the usual care group (n=113) did not complete the 6-month follow-up interview.
• Women in the BI group, compared with controls, reported significantly greater reductions from baseline to 6 months in number of standard drinks consumed (14.2-drink reduction versus 5.1), number of drinking days (3.4-day reduction versus 1.2), and number of heavy drinking days** (1.8-day reduction versus 0.5).

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* Eligible women reported at least 1 of the following in the 28 days prior to baseline interview: ≥20 standard drinks, ≥4 drinks on 4 or more occasions, or ≥20 drinking days.
** 4 or more drinks per day.
 
Comments by Tom Delaney, MSW, MPA
While postpartum BI cannot prevent fetal alcohol spectrum disorders (FASDs) in prior births, it may be a highly promising strategy for preventing FASDs in subsequent children. In this study, nurses and interviewers trained for the project conducted the intervention, so it remains unknown whether BI can be effectively delivered by obstetricians. Advocates for substance abuse prevention should take steps to ensure that postpartum medical care providers become aware of this effective evidence-based intervention.
 
Comments by Kevin L. Kraemer, MD, MSc
These findings suggest that BI can decrease alcohol use in postpartum women. It is important to note that 1209 women (14%) screened positive for at-risk drinking (including before and during pregnancy) but did not have sufficient alcohol use in the 28 days prior to the postpartum visit to meet the study criteria. This indicates that many women with at-risk drinking may be slow to return to drinking after delivery and will need to be re-screened periodically during the postpartum period and beyond.