Philip A May1, Anna-Susan Marais2, J Phillip Gossage3, Ronel Barnard2, Belinda Joubert2, Marise Cloete2, Natalie Hendricks2, Sumien Roux2, Annalien Blom2, Jeanetta Steenekamp2, Theresa Alexander2, Romena Andreas2, Suzanne Human2, Cudore Snell4, Soraya Seedat2, Charles C Parry5, Wendy O Kalberg3, David Buckley3, Jason Blankenship3. 1. 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. 2. Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa. 3. The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, New Mexico, U.S.A. 4. Howard University, School of Social Work, Washington, D.C., U.S.A. 5. Stellenbosch University, Faculty of Health Sciences, Department of Psychiatry, Tygerberg, Republic of South Africa ; Medical Research Council, Tygerberg, Republic of South Africa.
Abstract
AIM: 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 high documented rates of FASD. PARTICIPANTS: Forty-one women who were high risk for bearing a child with FASD. MEASURES: Statistical analysis of trends in drinking and other risk factors. FINDINGS: 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.
AIM: 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 high documented rates of FASD. PARTICIPANTS: Forty-one women who were high risk for bearing a child with FASD. MEASURES: Statistical analysis of trends in drinking and other risk factors. FINDINGS: 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.
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