Prenatal substance use policies and newborn health

Meinhofer, Angélica; Witman, Allison; Maclean, Johanna Catherine; Bao, Yuhua

doi:10.1002/hec.4518

Cited by 19 publications

(15 citation statements)

References 46 publications

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“…These findings are also consistent with the slightly larger body of literature examining pregnancy-specific drug policies, which also tends to find few infant health or health care utilization benefits associated with pregnancy-specific drug policies. 27,28 Combined with previous research, these results provide further evidence that adopting more of the extant type of pregnancy-specific alcohol policies should be paused and that repeal, or at least revision and improvement, of some policies is warranted.…”

Section: Jama Network Open | Substance Use and Addictionsupporting

confidence: 62%

Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment

et al. 2023

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ImportanceResearch has found associations of pregnancy-specific alcohol policies with increased low birth weight and preterm birth, but associations with other infant outcomes are unknown.ObjectiveTo examine the associations of pregnancy-specific alcohol policies with infant morbidities and maltreatment.Design, Setting, and ParticipantsThis retrospective cohort study used outcome data from Merative MarketScan, a national database of private insurance claims. The study cohort included individuals aged 25 to 50 years who gave birth to a singleton between 2006 and 2019 in the US, had been enrolled 1 year before and 1 year after delivery, and could be matched with an infant. Data were analyzed from August 2021 to April 2023.ExposuresNine state-level pregnancy-specific alcohol policies obtained from the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Policy Information System.Main Outcomes and MeasuresThe primary outcomes were 1 or more infant injuries associated with maltreatment and infant morbidities associated with maternal alcohol consumption within the first year. Logistic regression, adjusting for individual-level and state-level controls, and fixed effects for state, year, state-specific time trends, and SEs clustered by state were used.ResultsA total of 1 432 979 birthing person–infant pairs were included (mean [SD] age of birthing people, 32.2 [4.2] years); 30 157 infants (2.1%) had injuries associated with maltreatment, and 44 461 (3.1%) infants had morbidities associated with alcohol use during pregnancy. The policies of Reporting Requirements for Assessment/Treatment (adjusted odds ratio [aOR], 1.28; 95% CI, 1.08-1.52) and Mandatory Warning Signs (aOR, 1.18; 95% CI, 1.10-1.27) were associated with increased odds of infant injuries but not morbidities. Priority Treatment for Pregnant Women Only was associated with decreased odds of infant injuries (aOR, 0.83; 95% CI, 0.76-0.90) but not infant morbidities. Civil Commitment was associated with increased odds of infant injuries (aOR, 1.26; 95% CI, 1.08-1.48) but decreased odds of infant morbidities (aOR, 0.57; 95% CI, 0.53-0.62). Priority Treatment for Pregnant Women and Women With Children was associated with increased odds of both infant injuries (aOR, 1.12; 95% CI, 1.00-1.25) and infant morbidities (aOR, 1.08; 95% CI, 1.03-1.13). Reporting Requirements for Child Protective Services, Reporting Requirements for Data, Child Abuse/Neglect, and Limits on Criminal Prosecution were not associated with infant injuries or morbidities.Conclusions and RelevanceIn this cohort study, most pregnancy-specific alcohol policies were not associated with decreased odds of infant injuries or morbidities. Policy makers should not assume that pregnancy-specific alcohol policies improve infant health.

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Section: Jama Network Open | Substance Use and Addictionsupporting

confidence: 62%

Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment

et al. 2023

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“…Punitive state policies that use child welfare mechanisms and consider prenatal substance use to be child abuse or neglect have generally had no positive effect on birth outcomes 43 . In fact, recent studies have found that punitive policies are associated with decreased substance use treatment among pregnant individuals, increased reports of infant maltreatment, and increased neonatal withdrawal syndrome 44–46 . State policies focused on pregnant individuals are not unique to drug use and neither are the associated limited public health benefits 47 .…”

Section: Child Welfare Policies Regarding Substance Use In Pregnancymentioning

confidence: 99%

“…43 In fact, recent studies have found that punitive policies are associated with decreased substance use treatment among pregnant individuals, increased reports of infant maltreatment, and increased neonatal withdrawal syndrome. [44][45][46] State policies focused on pregnant individuals are not unique to drug use and neither are the associated limited public health benefits. 47 Punitive policies targeting prenatal alcohol use have become more common and have been associated with restrictions on reproductive rights.…”

Section: Child Welfare Policies Regarding Substance Use In Pregnancymentioning

confidence: 99%

Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy

et al. 2022

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r Over the past several decades, states have adopted policies intended to address prenatal drug use. Many of these policies have utilized existing child welfare mechanisms despite potential adverse effects. Recent federal policy changes were intended to facilitate care for substance-exposed infants and their families, but state uptake has been incomplete. intended to facilitate care for substance-exposed infants and their families, but implementation of these changes at the state level has been slowed and complicated by existing state policies. We seek to provide a timeline of state child welfare laws related to prenatal drug use and describe stakeholder perceptions of implementation. Methods:We catalogued child welfare laws related to prenatal drug use, including laws that defined child abuse and neglect and established child welfare reporting standards, for all 50 states and the District of Columbia (DC), from 1974 to 2019. In the 19 states that changed relevant laws between 2009 and 2019, qualitative interviews were conducted with stakeholders to capture statelevel perspectives on policy implementation.Findings: Twenty-four states and DC have passed laws classifying prenatal drug use as child abuse or neglect. Thirty-seven states and DC mandate reporting of suspected prenatal drug use to the state. Qualitative findings suggested variation in implementation within and across states between 2009 and 2019 and revealed that implementation of changes to federal law during that decade, intended to encourage states to provide comprehensive social services and linkages to evidence-based care to drug-exposed infants and their families, has been complicated by existing policies and a lack of guidance for practitioners.Conclusions: Many states have enacted laws that may disincentivize treatmentseeking among pregnant people who use drugs and lead to family separation. To craft effective state laws and support their implementation, state policymakers and practitioners could benefit from a treatment-oriented approach to prenatal substance use and additional state and federal guidance.

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“…Not all judicial system changes brought on in response to the opioid crisis have relaxed the enforcement of drug crime, however. For example, a few states have criminalized prenatal substance use, even though these laws have been shown to reduce reunification rates between infants in foster care and their biological mothers (Sanmartin et al 2020), to increase reports of child neglect to child protective agencies (Maclean et al 2022), and to increase rates of neonatal withdrawal symptoms (Meinhofer, Maclean, Witman, and Bao 2022).…”

Section: Trends In Crime Over the Opioid Crisismentioning

confidence: 99%

The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies

Maclean¹,

Mallatt²,

Ruhm³

et al. 2022

The ANNALS of the American Academy of Political and Social Scie

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We review quasi-experimental studies that examine the relationship of opioids to health, healthcare, and crime in the U.S. Our findings align with the general perception that the opioid crisis has negatively impacted health and increased healthcare costs; we find limited evidence that appropriate opioid use enhances work capacity or carries other benefits. Extant studies suggest that opioids also increase crime, although the link is not as strong as has been observed in previous drug epidemics. This finding is consistent with the fact that opioids are pharmacologically different than stimulant substances like cocaine that have dominated earlier drug epidemic periods. We argue that the healthcare system has a potentially important role to play in combatting the opioid crisis, largely through the provision of treatments that address underlying addiction, and through the development of strategies to effectively curtail access to the drugs.

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Prenatal substance use policies and newborn health

Cited by 19 publications

References 46 publications

Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment

Association of Pregnancy-Specific Alcohol Policies With Infant Morbidities and Maltreatment

Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy

The Opioid Crisis, Health, Healthcare, and Crime: A Review of Quasi-Experimental Economic Studies

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