Despite growing understanding of the impact of alcohol use during pregnancy on fetal outcomes, with results highlighting that no level of consumption can be considered safe, the majority of intervention programs that have been designed to prevent fetal alcohol exposure have either been informational campaigns or alcoholism treatment programs, of which few have been specifically designed for pregnant women. These types of interventions reach women at two ends of the drinking continuum: women who drink infrequently or women who are alcohol dependent. Few prevention programs have specifically targeted pregnant women who drink frequently but at lower levels, or who periodically drink excessively but would not be identified as alcohol dependent. Thus, women who drink at levels potentially harmful to the developing fetus, but who are not identified as problem drinkers, are often neglected in intervention efforts.

Derived from principals of social learning theory, brief intervention (BI) is an effective methodology that has been empirically validated to reduce consumption in a number of alcohol studies. 17 A recent randomized controlled trial suggests that pregnant women are particularly responsive to BI.18 The approach employs the use of brief counseling (10 TO 15 MINUTES) and can be delivered by personnel who are not specialists in the treatment of alcohol abuse or dependence.

BI has been shown to be a low-cost, effective treatment alternative for alcohol use problems that uses time-limited, self-help strategies to promote reductions in alcohol use in nondependent individuals, and in the case of dependent persons, to facilitate referral to specialized treatment programs.19

The six elements of BI are summarized by the acronym FRAMES: feedback, responsibility, advice, menu of strategies, empathy, and self-efficacy. Goal setting and follow up have been identified as important to the effectiveness of BI.

F-Feedback of Personal Risk. Most health professionals delivering brief intervention provide patients with feedback on their risks for alcohol problems. For pregnant women, the risk to the developing fetus and child is explained.

R-Responsibility of the Patient. Perceived personal control has been recognized to motivate behavior change. Therefore, brief intervention commonly emphasizes the patient' s responsibility and choice for reducing drinking. For example, you may tell a woman that "No one can make you change or make you decide to change. What you do about your drinking is up to you. But you can have a healthier baby if you stop drinking now."

A-Advice To Change. In some types of brief intervention, professionals give patients explicit advice to reduce or stop drinking. When working with a pregnant woman, the best advice is to abstain from alcohol use entirely.

M-Menu of Ways To Reduce Drinking. Health professionals providing brief intervention may offer patients a variety of strategies from which to choose. These may include learning to recognize the antecedents of drinking (risky situations) and developing skills to avoid drinking in high-risk situations (ways to avoid risky situations); planning ahead to limit drinking; pacing one's drinking (e.g., sipping, measuring, diluting, and spacing drinks); and learning to cope with the everyday problems that may lead to drinking. Health care professionals often give their patients self-help materials to present such strategies and to help them carry these strategies out. Self-help materials often include drinking diaries to help patients monitor their abstinent days and the number of drinks consumed on drinking days, record instances when they are tempted to drink or experience social pressure to drink, and note the alternatives to drinking that they use.

E-Empathetic Counseling Style. A warm, reflective, and understanding style of delivering BI is more effective than an aggressive, confrontational, or coercive style.

S-Self-Efficacy or Optimism of the Patient. Health professionals delivering brief intervention commonly encourage women to rely on their own resources to bring about change and to be optimistic about their ability to change their drinking behavior. BI often includes motivation-enhancing techniques (e.g., eliciting and reinforcing self-motivating statements, such as "I am confident that I can stop drinking," to encourage patients to develop, implement, and commit to plans to stop drinking).

Establishing a Drinking Goal. Patients are more likely to change their drinking behavior when they are involved in goal setting. The drinking goal usually is negotiated between the patient and health provider and may be presented in writing as a contract.

Follow up. The health care professional continues to follow up on the patient's progress and to provide ongoing support. Follow up may take the form of telephone calls from office staff or repeat visits to the provider. The woman is to be congratulated and encouraged at each follow up visit for her attempts to abstain from alcohol use or to cut down on her use.