Heavy Drinking

The heaviest drinkers are less likely to know that cutting back at any time during pregnancy can help the fetus.²³² Testa and Reifman suggested that heavydrinking women with children would benefit from a tailored message that points out "just because you had a healthy child the first time doesn't mean you will again. In fact, the research says that the more children you have the more likely they'll be affected if you continue to drink."²³⁴ Awareness efforts directed to this population need to acknowledge the challenge in making changes, and reinforce any reduction; they could also recognize the loneliness of choosing to abstain.²³⁵

It is important to point out that it is commonly believed that the most frequent and heavy substance users will not alter their use as a result of messaging alone. However, it is possible that the messages may at the very least contribute to a health-promoting environment that facilitates discussion of the issue, although this has not been studied to date. Where possible, basic messages about the potential harms of alcohol use during pregnancy need to lead to discussion and assessment concerning substance use problems.