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Drug-Alcohol & Pregnancy Policy Study (D-APPS)

ANSIRH is working collaboratively with the Pacific Institute for Research and Evaluation (PIRE), the Public Health Institute (PHI), and Penn State College of Medicine, to assess intended and unintended effects of both state-level policies targeting alcohol use during pregnancy (such as policies mandating the reporting of pregnant people who use alcohol to child welfare) and state-level general population alcohol policies (such as alcohol tax policies). Findings from this study will be used to inform ongoing policy debates as well as advocacy and professional education efforts by maternal and child health professionals and obstetricians and gynecologists.

In the first phase of this study, researchers answered the following questions:

Research Aims

Do pregnancy-specific alcohol policies lead to reductions in alcohol use during pregnancy?
Do pregnancy-specific alcohol policies improve birth outcomes, particularly low birth weight & Preterm Birth?
Do pregnancy-specific alcohol policies lead to increases in health care utilization?

Currently in the second phase of the study, researchers are looking to expand on the findings in phase one by assessing the relationship between pregnancy-specific and general population alcohol policies with infant maltreatment, infant morbidities, and maternal morbidities as well as treatment for alcohol use disorder during pregnancy. Researchers are also assessing relationships between general population alcohol policies and alcohol use among women of reproductive age and adverse birth outcomes.

Study Design

This study uses legal epidemiological methods to assess the impacts of policies on health outcomes. Researchers on this team have coded state policies for the purposes of analysis. Additional policy data are derived from the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) Alcohol Policy Information System. Data on birth and health outcomes are derived from multiple sources including the Behavioral Risk Factor Surveillance System, the National Alcohol Survey, Vital Statistics Birth and Mortality Data, the Treatment Episode Dataset, and private (Marketscan) and public (Medicaid) health insurance claims data.


In the first phase of the study, researchers found that at best, most pregnancy-specific alcohol policies do not affect alcohol use during pregnancy, birth outcomes, or prenatal care utilization. At worst, some of these policies lead to increases in low birthweight and preterm birth and to decreases in prenatal care utilization. Dr. Sarah Roberts discusses these results in the video below.

Results from the second phase of this project are expected to be published beginning in mid-2023.

Completed studies:

Issue Briefs


The research referenced on this page was supported by the U.S. National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health [Grants 1R01AA023267 and 2R01AA023267], by the University of California, San Francisco, California Preterm Birth Initiative, funded by Marc and Lynne Benioff, and other private foundations. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders.