Drug use and pregnancy policy study (D-APPS)

Principal Investigators:
Sarah Roberts, DrPH |  Ob/Gyn, Reproductive Sciences | UCSF School of Medicine

Background

State policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) have been in effect for more than 40 years.

Objective

As a supplement to a NIAAA-funded study where we examined whether policies affect preterm birth, and whether policy effects vary by race or socioeconomic status (SES), PTBi RAP funding supported explorations of whether alcohol/pregnancy policies also address drugs (drug/pregnancy policies) and dissemination to key California audiences. Entire study findings are summarized here.

Method

This legal epidemiology study used policy data and data for more than 150 million singleton births from birth certificates from 1972-2015.

Results

Alcohol/pregnancy policies typically cover drugs. The only exception is Mandatory Warning Signs, which have existed for alcohol, but not drugs, although this is changing with cannabis legalization. Half of alcohol/pregnancy policies led to increased preterm birth. In 2015 in the U.S., there were about 7000 excess preterm births due to Mandatory Warning Signs, 10,000 due to Priority Treatment, 4000 due to Prohibitions on Criminal Prosecution, and 12,000 due to Child Abuse/Neglect. Impacts varied by race and SES. Contrary to hypotheses, policies were associated with increased preterm birth for White and higher SES women and were not associated with preterm birth or were associated with decreased preterm birth for Black and lower SES women. Results for alcohol+drug pregnancy policies were mostly similar.

Conclusions