Using drink size to talk about drinking during pregnancy: A randomized clinical trial of Early Start Plus

The purpose of this study was to compare two brief alcohol use interventions in prenatal clinics. In this clinical trial, 15 Kaiser Permanente Northern California obstetric clinics were randomized to either usual care Early Start, a prenatal substance abuse screening and treatment program focused on abstention and integrated with prenatal care (n=417), or Early Start Plus, which supplemented Early Start with a computerized drink size assessment tool and intervention focused on helping women drink less (n=584). Controls included women who screened at risk for alcohol use during pregnancy at comparable Kaiser Permanente obstetric clinics without Early Start services (n=372). Recruitment occurred from 05/01/00-06/30/04. The groups were compared on neonatal and maternal outcomes, including neonatal assisted ventilation, low birthweight, preterm delivery, neonatal intensive care unit admission, infant or mother rehospitalization within two weeks of discharge from birth hospitalization, preterm labor, preeclampsia, placenta previa, and placental abruption. Controls had higher adverse outcome rates than the other two groups. In multivariate analysis, compared to Controls, statistically significant odds ratios were obtained for Early Start Plus for preterm labor (OR=0.44,p=0.04) and Early Start for low birthweight (OR =0.28,p=0.02). No differences in outcome rates between Early Start and Early Start Plus were statistically significant, suggesting that Early Start already provided a high standard of care. Early Start Plus was very well received by clinicians and clients alike. It provided clinicians with an innovative assessment tool that facilitated an open, in-depth dialogue about drinking during pregnancy that is difficult to develop when focusing singularly on abstention.