Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States.
Public Health Institute, 555 12th Street, Oakland, CA 94607, United States.
Alcohol Alcohol. 2023 Nov 11;58(6):645-652. doi: 10.1093/alcalc/agad056.
We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA.
We merged state-level policy and treatment admissions data for 1992-2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility.
When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10-1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04-1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08-1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00-1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72-0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78-0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions.
Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness.
我们研究了美国特定于妊娠的酒精政策与妊娠人群物质使用障碍治疗入院率之间的关系。
我们合并了 1992 年至 2019 年的州级政策和治疗入院数据。我们按州-年汇总数据，以检验九项特定于妊娠的酒精政策对报告酒精为治疗期主要、次要或次要物质的孕妇入院人数的影响（N=1331）。我们拟合泊松模型，该模型包含所有政策变量、州级对照、州和年份的固定效应、州特定时间趋势以及州-年的妊娠人数的偏移变量，以解释人口规模和生育率的差异。
当酒精被报告为主要物质时，民事拘留[发病率比（IRR）1.45，95%可信区间：1.10-1.89]和为评估和治疗目的而报告的要求[IRR 1.36，95%可信区间：1.04-1.77]与更多的治疗入院相关。对于酒精作为主要、次要或次要物质，民事拘留[IRR 1.31，95%可信区间：1.08-1.59]和为评估和治疗目的而报告的要求[IRR 1.21，95%可信区间：1.00-1.47]的发现类似，尽管强制性警告标志[IRR 0.84，95%可信区间：0.72-0.98]和为孕妇提供优先治疗[IRR 0.88，95%可信区间：0.78-0.99]与更少的治疗入院相关。在敏感性分析中，优先治疗的发现并不稳健。没有其他政策与治疗入院相关。
与更多治疗入院相关的特定于妊娠的酒精政策往往要求治疗，而不是使自愿治疗更容易获得，这引发了关于伦理和有效性的问题。
