title: Case Management Reduces Drinking During Pregnancy among High Risk Women.
abstract: OBJECTIVE
  Estimate the efficacy of Case Management (CM) for women at high risk for bearing a child with Fetal Alcohol Spectrum Disorders (FASD).
  
  
  METHODS
  Women were recruited from antenatal clinics and engaged in 18 months of CM.
  
  
  METHODS
  A South African community with a subculture of heavy, regular, weekend, recreational drinking and high documented rates of FASD.
  
  
  METHODS
  Forty-one women who were high risk for bearing a child with FASD.
  
  
  METHODS
  Statistical analysis of trends in drinking and other risk factors.
  
  
  RESULTS
  At intake 87.8% were pregnant, most had previous alcohol-exposed pregnancies, most/all of their friends drink alcohol (67.5%), 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 even though rising 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
  An enduring change in drinking behavior is difficult in this social setting. Yet, CM provided by skilled and empathic case managers reduced maternal drinking at critical times, and therefore, alcohol exposure levels to the fetus.
authors.affiliation: The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Nutrition Research Institute, U.S.A ; The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, New Mexico, U.S.A ; Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Anna-Susan
authors.initials: AS
authors.lastname: Marais
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, New Mexico, U.S.A.
authors.forename: J Phillip
authors.initials: JP
authors.lastname: Gossage
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Ronel
authors.initials: R
authors.lastname: Barnard
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Belinda
authors.initials: B
authors.lastname: Joubert
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Marise
authors.initials: M
authors.lastname: Cloete
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Natalie
authors.initials: N
authors.lastname: Hendricks
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Sumien
authors.initials: S
authors.lastname: Roux
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Annalien
authors.initials: A
authors.lastname: Blom
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Jeanetta
authors.initials: J
authors.lastname: Steenekamp
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Theresa
authors.initials: T
authors.lastname: Alexander
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Romena
authors.initials: R
authors.lastname: Andreas
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Human
authors.affiliation: Howard University, School of Social Work, Washington, D.C., U.S.A.
authors.forename: Cudore
authors.initials: C
authors.lastname: Snell
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa.
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.affiliation: Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa ; Medical Research Council, Tygerberg, Republic of South Africa.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Parry
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, New Mexico, U.S.A.
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, New Mexico, U.S.A.
authors.forename: David
authors.initials: D
authors.lastname: Buckley
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, New Mexico, U.S.A.
authors.forename: Jason
authors.initials: J
authors.lastname: Blankenship
keywords: alcohol abuse; case management; fetal alcohol spectrum disorders (FASD); prevention
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