Research Article: Costs associated with policies regarding alcohol use during pregnancy: Results from 1972-2015 Vital Statistics

Date Published: May 8, 2019

Publisher: Public Library of Science

Author(s): Meenakshi S. Subbaraman, Sarah C. M. Roberts, Kahabi Ganka Isangula.

http://doi.org/10.1371/journal.pone.0215670

Abstract

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.

Partial Text

As of 2016, 43 US states have policies regarding alcohol use during pregnancy [1]. These include mandatory warning signs (MWS), giving pregnant women priority for substance abuse treatment (PTPREG), giving pregnant women and women with children priority for substance abuse treatment (PTPREGWC), requiring reporting for either child welfare purposes (RRCPS) or data collection and treatment purposes (RRDTx), limiting criminal prosecution (LCP), allowing civil commitment (CC), and defining drinking during pregnancy as child abuse/neglect (CACN). Most of these, with the exception of MWS, apply to both alcohol and drug use during pregnancy [1].

Multivariable logistic regressions showed that four policies were significantly (P < 0.05) related to increases in LBW and PTB: mandatory warning signs, giving pregnant women priority for substance abuse treatment, limits on criminal prosecution, and defining substance use during pregnancy as child abuse/neglect. Specifically, 1) mandatory warning signs led to a 0.3% (95% CI: 0.2%, 0.5%) increase in LBW and a 0.3% (95% CI: 0.1%, 0.6%) increase in PTB; 2) priority treatment for pregnant women led to a 0.5% (95% CI: 0.3%, 0.7%) increase in LBW and a 0.6% (95% CI: 0.2%, 1.1%) increase in PTB; 3) limits on criminal prosecution led to a 0.5% (95% CI: 0.1%, 0.8%) increase in LBW and a 0.9% (95% CI: 0.4%, 1.5%) increase in PTB; and finally, 4) policies defining substance use during pregnancy as child abuse/neglect led to 0.3% (95% CI: 0.1%, 0.6%) increase in LBW and a 0.7% (95% CI: 0.4%, 1.1%) increase in PTB. The four remaining policies, i.e., civil commitment, reporting requirements for either CPS or data/treatment purposes, and prioritizing treatment for pregnant women and women with children were no significantly related to either LBW or PTB. Multiple state alcohol/pregnancy policies–specifically MWS, PTPREG, LCP, and CACN–lead to thousands of babies born low birthweight or preterm each year. These increased rates of adverse birth outcomes cost hundreds of millions of dollars in health care and related costs annually. The actual prevalence and associated costs indicate that the harms related to alcohol/pregnancy policies are not only statistically significant, but also significant from a public health and public policy perspective. As most alcohol/pregnancy policies (with the exception of MWS) also apply to drugs [1], findings from this study for all policies other than MWS can be interpreted as applying to alcohol+drug/pregnancy policies rather than specific to alcohol/pregnancy policies. The MWS finding in particular, though, suggests that as states continue to legalize recreational cannabis, public health policy makers may want to exercise caution before expanding MWS to apply to cannabis. Policymakers should consider the possibility of adverse public health impacts of alcohol+drug/pregnancy policies before expanding extant policies to new substances or adopting existing policies in new states.   Source: http://doi.org/10.1371/journal.pone.0215670

 

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