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

摘要 该项目采取了一项成功和富有成效的R01--药物-酒精怀孕政策研究(D-APPS) 阶段1-到下一个阶段，并进一步检查国家针对怀孕的酒精政策的影响和 扩展重点，以确定减少与饮酒有关的危害的一般人群酒精政策 怀孕了。酒精是一种已知的致畸物质，会导致胎儿酒精综合症和其他一系列危害 胎儿。怀孕期间饮酒很常见，15%的孕妇报告说曾饮酒和 3%的孕妇报告在过去的一个月里酗酒。尽管有相当多的政府和 临床对怀孕期间饮酒的关注，怀孕期间饮酒仍然很普遍， 在美国基本稳定了几十年。因此，评估哪些现有的特定于怀孕和一般的 人口酒精政策影响怀孕期间饮酒的危害势在必行。自20世纪70年代以来， 几乎所有的州都颁布了一项或多项与怀孕期间饮酒有关的政策。各州继续 制定专门针对怀孕的酒精政策。D-APPS第一阶段发现，大多数针对怀孕的酒精 政策导致低出生体重和早产的增加，以及产前护理的减少，这导致 每年有数以千计的婴儿出生时体重偏低或早产。研究结果表明，虽然在饮酒期间 怀孕会危害公共健康，因此采取的应对政策也是如此。在放弃怀孕之前- 具体的酒精政策，需要进行研究，看看是否对更严重的结果有任何积极影响 与怀孕期间饮酒有关的问题，如儿童疾病和虐待儿童。其他研究 还需要确定其他可能的政策，以减少怀孕期间饮酒的危害。 针对酒类价格和可获得性以及将饮酒定为刑事犯罪的一般人口酒精政策 行为也可以减少与怀孕期间饮酒有关的危害，但这一点尚未被研究 全面的。在这个项目中，我们评估了现有的怀孕特定酒精政策是否会影响其他 与怀孕期间饮酒有关的结果，并确定减少饮酒的一般人群酒精政策 与怀孕期间饮酒有关的危害。我们研究了影响是否因种族/民族而不同 社会经济地位以及当时正在实施的其他政策也是如此。这项研究使用的是保险索赔 和治疗事件数据集-1990年代的入院数据-目前，出生数据和国家 20世纪70年代至今的酒精调查数据，NIAAA的酒精政策信息系统，以及其他政策 数据源。我们将使用流行病学和基于经济学的数据分析方法来考虑 对调查结果的因果解释。调查结果将为正在进行的政策辩论、倡导和专业人士提供信息 妇幼保健专业人员以及产科医生和妇科医生的教育努力，并向 减少怀孕期间饮酒危害的政策方法。

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.