Alcohol and pregnancy: Benefits and harms of pregnancy-specific alcohol policies among maternal-infant dyads covered by Medicaid.

Abstract

Previous research finds pregnancy-specific alcohol policies are associated with adverse infant/maternal outcomes among people covered by commercial insurance. Here, we examine whether findings generalize to people covered by Medicaid. In this retrospective cohort study, we combined outcome data on births from 2000 to 2019 from Medicaid Analytic eXtract and Transformed Medicaid Statistical Information System Analytic Files databases with pregnancy-specific alcohol policy data. Outcomes included infant morbidities related to maternal alcohol consumption, infant injuries consistent with maltreatment at 50% and 75% positive predictive value (PPV), severe maternal morbidities (SMM), and infant healthcare utilization. Adjusted analyses used logistic regression with individual- and state-level controls, state- and year-fixed effects, state-specific time trends, and standard errors clustered by state. We replicated analyses with models stratified by race/ethnicity. The cohort included 10,329,565 maternal-infant dyads. 2.4% had an infant morbidity; 3.0% and 0.3% had injuries with 50% and 75% PPV respectively; 4.2% experienced a SMM. Only one policy - Reporting Requirements for Assessment/Treatment - was robustly associated with improvements in all outcomes (ranging from aOR 0.86 95% CI 0.82, 0.89 for SMM to 0.95 95% CI 0.92, 0.99 for infant injuries 50% PPV). One policy - Reporting Requirements for Child Protective Services - was robustly associated with detriments in infant outcomes (aORs of 1.14 95% CI 1.08, 1.19 for infant morbidities and 1.19 95% CI 1.06, 1.35 for infant injuries 75% PPV) but not SMM (aOR 0.92 95% CI 0.88, 0.96). For other policies, improvements in one outcome were offset by detriments in another or among a racial/ethnic subgroup. While some individual pregnancy-specific alcohol policies were associated with benefits among births covered by Medicaid, benefits were often offset by adverse effects. Policymakers should not assume pregnancy-specific alcohol policies improve infant/maternal health.