Compared to brief advice, the CHOICES Plus intervention significantly lowered the risk of alcohol- and tobacco-exposed pregnancies among women in a low-income primary care population. This US-based trial illustrates the efficacy of a bundle of ‘pre-conception’ services for risky drinking, smoking, and ineffective contraception.

Key points From summary and commentary:

• The CHOICES Plus trial tested a bundle of services in predominantly low income primary care settings, addressing risky drinking, smoking, and ineffective contraception among ‘at risk’ women.
• After nine months, women assigned to the intervention had a significantly lower risk of alcohol- and tobacco-exposed pregnancies than women assigned to brief advice.
• Targeting interventions at women before they become pregnant could shift the focus in clinical practice from treatment of substance-exposed pregnancies to prevention of a major (and costly) public health concern 

[See also the CDC CHOICES website]