Preconception interventions to reduce the risk of alcohol‐exposed pregnancies: A systematic review

The preconception period provides a unique opportunity to optimize the health of women and children. High rates of alcohol use and unintended pregnancies are common across many Western societies and alcohol exposed pregnancies (AEPs) are a possible unintended outcome. The aim of the current study was to evaluate preconception interventions for the prevention of AEPs. A systematic search of four electronic databases (PubMed, Embase, CINAHL and PsycINFO) was undertaken for relevant peer-reviewed articles published from 1970 onwards. Studies were included if they included women and/or their support networks during the preconception period. Nineteen studies met the inclusion criteria. The majority of studies (n = 14) evaluated CHOICES-based interventions, which incorporates motivational interviewing approaches to change alcohol and/or contraceptive behavior. The five other interventions included a range of different approaches and modes of delivery. The majority of included interventions were successful in reducing AEP risk. Changes in AEP risk were more often driven through changes in contraceptive behavior, although some approaches led to changes in both alcohol and contraceptive behavior. The review indicated that many interventions were efficacious at reducing AEP risk during the preconception period through preventing unplanned pregnancy. The effectiveness estimated from these clinical trials may be greater than would be seen once the interventions are implemented in practice due to lack of blinding and attrition of participants during follow-up. Further research investigating the real-world effectiveness of these intervention approaches implemented across a wide range of clinical settings would be beneficial.