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As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive\u2010based text\u2010messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single\u2010arm pilot trial was conducted over 3\u2009months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three\u2010month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health\u2010related text messaging from an evidence\u2010based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self\u2010reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post\u2010enrollment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9\u2009days at baseline, on average, to 1\u20133\u2009days (<jats:italic>p<\/jats:italic>\u2010value range: 0.144\u20130.010) at follow\u2010up timepoints. There were statistically significant increases in the proportions of participants with alcohol\u2010negative urine tests (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3\u2009months in the overall sample and among those enrolled postpartum, though these were not significant (<jats:italic>p<\/jats:italic>\u2010value range: 0.255\u20130.147). Maternal depression scores also decreased among participants enrolled postpartum (<jats:italic>p<\/jats:italic>\u2009=\u20090.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow\u2010ups in the overall sample (<jats:italic>p<\/jats:italic>\u2009=\u20090.032) and among participants enrolled while pregnant (<jats:italic>p<\/jats:italic>\u2009=\u20090.015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study is among the first to pilot test an incentive\u2010based text\u2010messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well\u2010powered, randomized controlled trial.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.15392","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T11:49:01Z","timestamp":1718624941000},"page":"1600-1609","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["An incentive\u2010based text\u2010messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single\u2010arm pilot study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3882-2953","authenticated-orcid":false,"given":"Yukiko","family":"Washio","sequence":"first","affiliation":[{"name":"Substance Use, Gender and Applied Research RTI International  Research Triangle Park North Carolina USA"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences Temple University Lewis Katz School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1136-1202","authenticated-orcid":false,"given":"Lesley\u2010Ann","family":"Erasmus\u2010Claassen","sequence":"additional","affiliation":[{"name":"Mental Health, Alcohol, Substance Use and Tobacco Research Unit South African Medical Research Council  Tygerberg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shantae N.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Substance Use, Gender and Applied Research RTI International  Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zugui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Christiana Care Health System Institute for Research on Equity and Community Health  Newark Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia A.","family":"Browne","sequence":"additional","affiliation":[{"name":"Substance Use, Gender and Applied Research RTI International  Research Triangle Park North Carolina USA"},{"name":"Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronwyn","family":"Myers","sequence":"additional","affiliation":[{"name":"Mental Health, Alcohol, Substance Use and Tobacco Research Unit South African Medical Research Council  Tygerberg South Africa"},{"name":"Department of Psychiatry and Mental Health University of Cape Town  Cape Town South Africa"},{"name":"Curtin enAble Institute Curtin University  Bentley Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendee M.","family":"Wechsberg","sequence":"additional","affiliation":[{"name":"Substance Use, Gender and Applied Research RTI International  Research Triangle Park North Carolina USA"},{"name":"Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Psychiatry and Behavioral Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-2785","authenticated-orcid":false,"given":"Charles D. 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