Critical Windows for Perinatal Health: Evaluating the Impacts of Timing of Poverty Alleviation Benefits.

Abstract

The earned income tax credit, the largest U.S. poverty alleviation program for families with children, provides tax refunds to low-income working families and has been shown to improve perinatal outcomes and reduce racial/ethnic inequities. Variation in when earned income tax credit refunds are received during pregnancy allows for a natural experiment of the timing of income receipt on perinatal health. National birth certificate data from 2010 to 2019 and a difference-in-differences study design were used to examine whether the trimester of earned income tax credit disbursal affects the likelihood of adverse perinatal outcomes. Analysis was performed in 2025. Earned income tax credit disbursal during any trimester compared with that before conception was associated with higher birthweight and lower likelihood of preterm birth (<37-week gestational age) and low birthweight (<2,500 grams), with the strongest association in the third trimester (17.81 grams increase in birthweight, 2.16 percentage point decrease in preterm birth, and 1.19 percentage point decrease in low birthweight). Earned income tax credit disbursal during most trimesters of pregnancy was associated with higher prevalence of small-for-gestational age, gestational diabetes, and gestational hypertension than disbursal before conception. Associations were generally weaker among individuals who were non-White, unmarried, and foreign born and in states without their own earned income tax credit policies. With increasing interest in poverty alleviation during pregnancy to address perinatal health inequities, these results inform timing of interventions.