Mandatory warning signs for alcohol use during pregnancy and birth and infant outcomes in southern United States: a quasi-experimental study

Introduction Policies mandating posting of signs warning of the risks of alcohol consumption during pregnancy (MWS-alcohol-pregnancy) are common in the United States Previous research suggests these policies are ineffective and relate to increased adverse infant and maternal outcomes. Research about MWS-alcohol-pregnancy using quasi-experiments is needed. Materials and Methods This study uses Vital Statistics birth certificate data and commercial insurance claims data from Merative MarketScan® and policy data from NIAAA’s Alcohol Policy Information System. We systematically selected a treatment (Texas) and comparison (Florida) state for a quasi-experimental examination of effects of an MWS-alcohol-pregnancy policy going into effect in 2007. Difference-in-difference models compared changes in birthweight, low-birthweight, and infant injuries consistent with maltreatment from pre- to post-policy change between the treatment and comparison state. Results Mean birthweight decreased 4.06 g more from pre- to post-periods in the treatment as compared to the comparison (average treatment effect on the treated [ATET] -4.06, 95% CI -7.02, −1.09) state. The difference in the pre- to post-policy change in low-birthweight in the treatment relative to the comparison state was not statistically significant (ATET .0 pp, 95% CI -.0, .0). The pre- to post-policy change in infant maltreatment was .5 percentage points greater in the treatment relative to the comparison state (ATET .5 pp, 95% CI .2, .8). Conclusions The MWS-alcohol-pregnancy policy was associated with lower birthweight and more infant maltreatment. This study provides further evidence that MWS-alcohol-pregnancy policies are mostly ineffective and possibly harmful.