Intervention Models and Behaviour Change Techniques to Reduce the Risk of Alcohol Exposed Pregnancies: A Systematic Review of Interventions for Non-pregnant Women.

Trials of behavioural interventions aimed at preventing an Alcohol-Exposed Pregnancy (AEP) before conception report variable effectiveness. Understanding which intervention components, such as Behaviour Change Techniques (BCTs), are effective is essential when adapting for real-world implementation. This review describes the intervention models, the BCTs utilised, and the BCT combinations in effective interventions. An earlier systematic review of studies published from 1970 to 2018 was updated using the same search strategy to identify additional articles published subsequently. Searches were conducted on CINAHL, PsycINFO, Embase and PubMed to identify studies published between 2019 and 2025. Eligible study designs were randomised controlled trials (RCTs), non-randomised comparative studies, cohort studies and before-and-after studies. Studies were included if they were in English, included non-pregnant women of reproductive age or their social networks and aimed to prevent AEP. Outcomes reviewed were measures of knowledge of guidelines and attitudes towards alcohol consumption in pregnancy or when planning a pregnancy, changes in alcohol consumption and changes in behaviours to prevent unplanned pregnancies, such as effective contraception use at every sexual encounter that could lead to pregnancy. Narrative synthesis was used to describe intervention models and annotate BCTs guided by the BCT Ontology (BCTO) and alcohol-specific taxonomy. Risk of bias was assessed using the ROB 2 tool and the Modified Downs and Black Checklist. Twenty-five studies, comprising 18 studies from the previous systematic review and seven published between 2019 and 2025, were identified with 6,020 participants. Three intervention models were identified: (i) alcohol-only educational, (ii) alcohol-only screening and brief interventions (SBIs), and (iii) dual-focused (alcohol and contraception) interventions. Models included single- and multiple-session interventions, which were delivered face-to-face, remotely or digitally. Fifty-one BCTs were coded across all studies. Within the alcohol-only SBIs and dual-focused (alcohol and contraception) models, multi-session interventions generally demonstrated greater effects in intervention groups than controls and utilised more BCTs from the goal-directed and monitoring BCTO groups compared to single-session interventions. These findings deepen our understanding of why some interventions are more effective than others and suggest that tailored interactions with certain goal-directed and monitoring BCTs may enhance their effectiveness. Future research can explore greater incorporation of BCT combinations from these groups into single-session interventions and pathways to identify women who need more intense interventions for referral or support.