In a study published on Wednesday in the journal PLOS One and provided to Vox exclusively ahead of publication, Meenakshi S. Subbaraman, a biostatistician at the Public Health Institute, and Sarah C.M. Roberts, an associate professor of obstetrics and gynecology in UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) research group, looked at state policies designed to stop pregnant women from drinking. They found that several of these policies, including posting warning signs in bars and restaurants and defining drinking while pregnant as child abuse or neglect, are actually associated with worse health outcomes for babies, specifically low birth weight and premature birth. One reason, the researchers say, is that the policies can actually discourage women from seeking prenatal care.
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Background and objective
As of 2016, 43 US states have policies regarding alcohol use during pregnancy. A recent study found that out of eight state-level alcohol/pregnancy policies, six are significantly associated with poorer birth outcomes, and two are not associated with any outcomes. Here we estimate the excess numbers of low birthweight (LBW) and preterm births (PTB) related to these policies and their associated additional costs in the first year of life.
Cost study using birth certificate data for 155,446,714 singleton live births in the United States between 1972–2015. Exposures were state- and month/year-specific indicators of having each of eight alcohol/pregnancy policies in place. Outcomes were excess numbers of LBW and PTB and associated costs in the first year of life. Fixed effects regressions with state-specific time trends were used for statistical analyses in 2018.
In 2015, policies mandating warning signs were associated with an excess of 7,375 LBW; policies defining alcohol use during pregnancy as child abuse/neglect were associated with an excess of 12,372 PTB; these excess adverse outcomes are associated with additional costs of $151,928,002 and $582,698,853 in the first year of life, respectively.
Multiple state-level alcohol pregnancy policies lead to increased prevalence of LBW and PTB, which cost hundreds of millions of dollars annually. Policymakers should consider adverse public health impacts of alcohol/pregnancy policies before expanding extant policies to new substances or adopting existing policies in new states.