Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study

Drug Alcohol Depend. 2019 Aug 1;201:244-252. doi: 10.1016/j.drugalcdep.2019.04.020. Epub 2019 Jun 19.


Objectives: State policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) have been in effect for more than 40 years. Previous research finds some policies increase adverse birth outcomes and decrease prenatal care utilization. This research examines whether effects of alcohol/pregnancy policies vary by race; the general hypothesis is that health benefits of policies are concentrated among White women and health harms of policies are concentrated among Black women.

Methods: This study uses 1972-2015 Vital Statistics data and policy data from NIAAA's Alcohol Policy Information System and original legal research. The dataset includes more than 150 million singleton births. Outcomes are preterm birth (PTB), low birthweight (LBW), and prenatal care utilization. Logistic regression models include raceXpolicy interaction terms as main predictors, adjust for individual- and state-level controls, include fixed effects for state, year and state-specific time trends, and account for clustering by state.

Results: The impact of alcohol/pregnancy policies varied by race for preterm birth, varied in a few cases for low birthweight, and generally did not vary for prenatal care utilization. The hypothesis regarding the direction of differential effects was not supported. Six policies had an adverse impact on PTB and/or LBW for White women. Findings differed for Black women; for Black women, four policies had a beneficial impact for PTB and one had an adverse impact for LBW.

Conclusions: The impact of alcohol/pregnancy policies on birth outcomes varies by race. Future research should explore why some policies appear to have opposite effects for White v. Black women.

Keywords: Alcohol; Legal epidemiology; Pregnancy; Race.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • African Americans / legislation & jurisprudence
  • African Americans / psychology*
  • Female
  • Humans
  • Infant, Newborn
  • Legal Epidemiology*
  • Middle Aged
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy Outcome / psychology*
  • Prenatal Care / methods
  • Prenatal Care / psychology*
  • Whites / legislation & jurisprudence
  • Whites / psychology*
  • Young Adult