Associations Between State Alcohol Policy Environment and Infant and Maternal Outcomes: A Retrospective Cohort Study.

Abstract

The Alcohol Policy Scale, a measure of the broader alcohol policy environment in the U.S., consistently relates to improved health outcomes. Whether the Alcohol Policy Scale identifies policy environments that might reduce adverse effects from drinking during pregnancy is unknown. Alcohol Policy Scale total composite score and Alcohol Policy Scale consumption-oriented and Alcohol Policy Scale driving-oriented subscale data were combined with outcome data from birth certificates and commercial insurance claims to examine the associations between the Alcohol Policy Scale and infant and maternal outcomes from 2000 to 2019. Outcomes included birth outcomes (birthweight, low birthweight, gestation, preterm birth), infant outcomes (infant morbidities related to maternal alcohol consumption, infant injuries consistent with maltreatment), and severe maternal morbidities. Analyses were conducted in 2024-2025 and used linear and logistic regression with individual- and state-level controls, state- and year-fixed effects, state-specific time trends, and SEs clustered by state. The Alcohol Policy Scale was associated only with birthweight. As the Alcohol Policy Scale indicated stricter policy environments, birthweight decreased (coefficient= -0.45, 95% CI= -0.84, -0.05). The consumption subscale was associated only with severe maternal morbidities; as the subscale indicated stricter environments, odds of severe maternal morbidities increased (AOR=1.03, 95% CI=1.00, 1.06). The driving subscale was associated only with birthweight and infant injuries; as the subscale indicated stricter environments, birthweight decreased (coefficient= -0.14, 95% CI= -0.26, -0.01) as did the odds of infant injuries (AOR=0.99, 95% CI=0.97, 1.00). All findings were no longer statistically significant in 1 or more sensitivity analyses. The Alcohol Policy Scale does not appear relevant for identifying alcohol policy environments that might reduce adverse effects from drinking during pregnancy.