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Alcohol, tobacco, and marijuana use during pregnancy pose significant, yet preventable, risks to the developing fetus. Because many pregnancies are unintended, substance use often continues into the first trimester and beyond. CHOICES, a preconception intervention, has previously been shown to reduce the risk of alcohol- and tobacco-exposed pregnancies. Building on this foundation, the current study tested the efficacy of CHOICES4Health (C4H), a preconception intervention aimed at reducing the risk of alcohol-, tobacco-, and marijuana-exposed pregnancies (AEP, TEP, MEP). A secondary aim was to compare the efficacy of a tablet-delivered intervention with a person-delivered format.
Methods
This randomized controlled trial included three intervention groups: person-delivered C4H (CFH-P; n = 74), tablet-delivered C4H (C4H-T; n = 76), and a Brief Advice control (n = 69). Data were collected from April 2015 through December 2020.
Participants were recruited from 12 primary care clinics in a large Texas public healthcare system. Eligible women were aged 18–44, non-pregnant, non-sterile, sexually active, and not using effective contraception (N = 219). Inclusion criteria required one or more of the following: drinking more than three drinks per day or more than seven drinks per week in the past 90 days; using marijuana at least two to three times per month in the past 90 days; or smoking cigarettes (even a puff) within the past seven days.
Both CFH-P and CFH-T participants completed two intervention sessions and a contraceptive visit. CFH-P was delivered by a master’s-level social workers and other behavioral health specialists, while CFH-T was delivered via tablet. The Brief Advice condition included one session with referral to community resources.
The primary outcomes were reductions in the risk of AEP, TEP, and MEP over a 9-month follow-up.
Results
In intention-to-treat analyses across 9 months, the C4H-T group was significantly more likely than the Brief Advice group to reduce risk of AEP (OR = 3.54, 95% CI [1.22, 10.24]), MEP (OR = 6.38, 95% CI [1.20, 33.80]), and TEP (OR = 6.14, 95% CI [1.32, 28.61]). The C4H-P group was also more likely than the Brief Advice group to reduce risk of AEP (OR = 2.16, 95% CI [0.76, 6.14]) and MEP (OR = 6.98, 95% CI [1.32, 36.89]).
Conclusions and Implications
C4H significantly reduced the risk of substance-exposed pregnancy. Preventing alcohol, tobacco, and marijuana exposure before pregnancy occurs can reduce unintentional fetal exposure when pregnancies are not planned.