Alcohol and pregnancy: benefits and harms of state-level policies

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Abstract This project takes a successful and productive R01 – the Drug-Alcohol Pregnancy Policy Study (D-APPS) Phase 1 – to the next phase and further examines impacts of state pregnancy-specific alcohol policies and expands focus to identify general population alcohol policies that reduce harms related to alcohol use during pregnancy. Alcohol is a known teratogen that causes fetal alcohol syndrome and a range of other harms to fetuses. Alcohol use during pregnancy is common, with 15% of pregnant women reporting any alcohol use and 3% of pregnant women reporting binge drinking in the past month. Despite considerable governmental and clinical attention to alcohol use during pregnancy, alcohol use during pregnancy has remained common and essentially stable for decades in the U.S. Thus, assessing which existing pregnancy-specific and general population alcohol policies influence harm from alcohol use during pregnancy is imperative. Since the 1970s, almost all states have enacted one or more policies related to alcohol use during pregnancy. States continue to enact pregnancy-specific alcohol policies. D-APPS Phase 1 found that most pregnancy-specific alcohol policies lead to increases in low birthweight and preterm birth and decreases in prenatal care, which results in thousands of babies born low birthweight or preterm each year. Findings indicate that while alcohol use during pregnancy causes public health harms, so do the policies adopted in response. Before abandoning pregnancy- specific alcohol policies, research is needed to see if there are any positive impacts on more severe outcomes related to alcohol use during pregnancy, such as child morbidities and child maltreatment. Additional research is also needed to identify other possible policies that might reduce harms from drinking during pregnancy. General population alcohol policies that address price and availability of alcohol and criminalization of drinking behavior could also reduce harm related to drinking during pregnancy, but this has not yet been studied comprehensively. In this project, we assess whether existing pregnancy-specific alcohol policies affect other outcomes related to drinking during pregnancy and identify general population alcohol policies that reduce harms related to drinking during pregnancy. We examine whether effects differ by race/ethnicity and socioeconomic status as well as by the other policies in effect at the time. This study uses insurance claims and Treatment Episode Dataset-Admissions data from the 1990s-present, Natality Birth Data and National Alcohol Survey Data from the 1970s-present, NIAAA's Alcohol Policy Information System, and other policy data sources. We will use both epidemiologic and economics-based data analysis approaches to allow for causal interpretation of findings. Findings will inform ongoing policy debates, advocacy and professional education efforts by maternal and child health professionals and obstetricians and gynecologists, and inform policy approaches to reduce harms from drinking during pregnancy.