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. 2023 Nov 11;58(6):645-652.
doi: 10.1093/alcalc/agad056.

Pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA

Nancy F Berglas  1 , Meenakshi S Subbaraman  2 , Sue Thomas  3 , Sarah C M Roberts  1
Affiliations

Pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA

Nancy F Berglas et al. Alcohol Alcohol. .

Abstract

Aims: We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA.

Methods: We merged state-level policy and treatment admissions data for 1992-2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility.

Results: When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10-1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04-1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08-1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00-1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72-0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78-0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions.

Conclusions: Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness.

Keywords: alcohol; policy; pregnancy.

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Figures

Figure 1
Figure 1
Number of U.S. states with pregnancy-specific alcohol policies, 1992–2019.
See this image and copyright information in PMC

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