Case management reduces drinking during pregnancy among high-risk women

Aim: To estimate the efficacy of Case Management (CM) for women at high risk for bearing a child with Fetal Alcohol Spectrum Disorders (FASD). Design: Women were recruited from antenatal clinics and engaged in 18 months of CM. Setting: A South African community with a subculture of heavy, regular, weekend, recreational drinking and with high documented rates of FASD. Participants: Forty-one women who were at high risk for bearing a child with FASD. Measures: Statistical analysis of trends in drinking and other risk factors. Findings: At intake, 87.8% of the women were pregnant, most had previous alcohol-exposed pregnancies, 67.5% reported that most or all of their friends drank alcohol, and 50.0% had stressful lives. CM was particularly valuable for pregnant women, as statistically significant reductions in alcohol risk were obtained for them in multiple variables: total drinks on weekends after six months of CM (p = .026) and estimated peak blood alcohol concentration (BAC) at six (p < .001) and 18 months (p < .001). For participants completing 18 months of CM, AUDIT scores improved significantly by 6-month follow-up (from 19.8 to 9.7, p = .000), and although there were increases at 12 and 18 months, AUDIT scores indicate that problematic drinking remained statistically significantly lower than baseline throughout CM. Happiness scale scores correlated significantly with reduced drinking in most time periods. Conclusions: Making an enduring change in drinking behavior is difficult in this social setting. Nonetheless, CM provided by skilled and empathic case managers reduced maternal drinking at critical times, and, therefore, alcohol exposure levels to the fetus.