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Alcohol Clin Exp Res. 2018 Jun 18. doi: 10.1111/acer.13804. [Epub ahead of print]

Associations Between State-Level Policies Regarding Alcohol Use Among Pregnant Women, Adverse Birth Outcomes, and Prenatal Care Utilization: Results from 1972 to 2013 Vital Statistics.

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Alcohol Research Group , Emeryville, California.
Pacific Institute of Research and Evaluation , Santa Cruz, California.
Department of Psychiatry , University of California, San Francisco, San Francisco, California.
Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California.



Policies regarding alcohol use during pregnancy continue to be enacted and debated in the United States. However, no study to date has examined whether these policies are related to birth outcomes-the outcomes they ultimately aim to improve. Here, we assessed whether state-level policies targeting alcohol use during pregnancy are related to birth outcomes, which has not been done comprehensively before.


The study involved secondary analyses of birth certificate data from 148,048,208 U.S. singleton births between 1972 and 2013. Exposures were indicators of whether the following 8 policies were in effect during gestation: Mandatory Warning Signs (MWS), Priority Treatment for Pregnant Women, Priority Treatment for Pregnant Women/Women with Children, Reporting Requirements for Data and Treatment Purposes, Prohibitions Against Criminal Prosecution, Civil Commitment, Reporting Requirements for Child Protective Services Purposes, and Child Abuse/Child Neglect. Outcomes were low birthweight (<2,500 g), premature birth (<37 weeks), any prenatal care utilization (PCU), late PCU, inadequate PCU, and normal (≥7) APGAR score. Multivariable fixed-effect logistic regressions controlling for both maternal- and state-level covariates were used for statistical analyses.


Of the 8 policies, 6 were significantly related to worse outcomes and 2 were not significantly related to any outcomes. The policy requiring MWS was related to the most outcomes: specifically, living in a state with MWS was related to 7% higher odds of low birthweight (p < 0.001); 4% higher odds of premature birth (p < 0.004); 18% lower odds of any PCU (p < 0.001); 12% higher odds of late PCU (p < 0.002); and 10% lower odds of a normal APGAR score (p < 0.001) compared to living in a state without MWS.


Most policies targeting alcohol use during pregnancy do not have their intended effects and are related to worse birth outcomes and less PCU.


Alcohol; Birth Outcomes; Policy; Pregnancy; Vital Statistics


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