title: Reducing alcohol use during pregnancy via health counseling by midwives and internet-based computer-tailored feedback: a cluster randomized trial.
abstract: BACKGROUND
  Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy. Currently, health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use. Thus, more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy. An alternative and promising strategy is computer tailoring. However, to date, no study has shown the effectiveness of this intervention mode.
  
  
  OBJECTIVE
  The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol.
  
  
  METHODS
  A total of 60 Dutch midwifery practices, randomly assigned to 1 of 3 conditions, recruited 135 health counseling, 116 computer tailoring, and 142 usual care respondents from February to September 2011. Health-counseling respondents received counseling from their midwife according to a health-counseling protocol, which consisted of 7 steps addressed in 3 feedback sessions. Computer-tailoring respondents received usual care from their midwife and 3 computer-tailored feedback letters via the Internet. Usual care respondents received routine alcohol care from their midwife. After 3 and 6 months, we assessed the effect of the interventions on alcohol use.
  
  
  RESULTS
  Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents 6 months after baseline (53/68, 78% vs 51/93, 55%; P=.04). Multilevel multiple linear regression analyses showed that computer-tailoring respondents (mean 0.35, SD 0.31 units per week) with average (P=.007) or lower (P<.001) alcohol use before pregnancy or with average (P=.03) or lower (P=.002) social support more strongly reduced their alcohol use 6 months after baseline compared to usual care respondents (mean 0.48, SD 0.54 units per week). Six months after baseline, 72% (62/86) of the health-counseling respondents had stopped using alcohol. This 17% difference with the usual care group was not significant.
  
  
  CONCLUSIONS
  This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy; health counseling did not effectively reduce alcohol use. Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers. Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person's anonymity, this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol.
  
  
  BACKGROUND
  Dutch Trial Register NTR 2058; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2058 (Archived by WebCite at http://www.webcitation.org/6NpT1oHol).
authors.affiliation: Dutch Institute for Alcohol Policy STAP, Utrecht, Netherlands. nvanderwulp@stap.nl.
authors.forename: Nickie Y
authors.identifier: http://orcid.org/0000-0003-1036-9808
authors.initials: NY
authors.lastname: van der Wulp
authors.forename: Ciska
authors.identifier: http://orcid.org/0000-0003-1357-863X
authors.initials: C
authors.lastname: Hoving
authors.forename: Kim
authors.identifier: http://orcid.org/0000-0003-1491-8907
authors.initials: K
authors.lastname: Eijmael
authors.forename: Math J J M
authors.identifier: http://orcid.org/0000-0002-2229-1131
authors.initials: MJ
authors.lastname: Candel
authors.forename: Wim
authors.identifier: http://orcid.org/0000-0002-1998-6143
authors.initials: W
authors.lastname: van Dalen
authors.forename: Hein
authors.identifier: http://orcid.org/0000-0002-3640-2517
authors.initials: H
authors.lastname: De Vries
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D003376:Counseling; D005260:Female; D006801:Humans; D020407:Internet; D007721:Knowledge of Results, Psychological; D009721:Nurse Midwives; D011247:Pregnancy; D011295:Prenatal Care; D012944:Social Support; D055815:Young Adult
keywords: alcohol drinking; counseling; midwifery; pregnancy; telemedicine