Association for Public Policy Analysis & Management

Substance use during pregnancy can cause severe, life-long harm to the baby. According to the National Survey on Drug Use and Health (2011), 5% of pregnant women aged 15-44 reported using illicit drugs, 9% reported using alcohol, and 17% reported using cigarettes. Tennessee was the first state to criminalize prenatal substance abuse in 2014. In other states, considerable variation over time exists in how prenatal substance use is handled by the law. For example, prenatal substance use is treated as child abuse in many states. Other states provide drug treatment programs specifically for pregnant women. In this paper, we consider the effects of state policy variation surrounding prenatal substance use on infant outcomes. The policy data is drawn from the Guttmacher Institute’s State Policies in Brief: Substance Abuse During Pregnancy from 2002-2012. The infant outcomes data are gathered from the Hospital Cost and Utilization Project (HCUP), which includes data on hospital stays. We use data from the HCUP State Inpatient Database (SID) from 2002-2012, which includes the universe of inpatient discharge records from community hospitals by state (47 states participate in the SID). We use these data to identity the number of discharges for the following ICD-9 codes: 1) narcotics affecting fetus or newborn via placenta or breast milk; 2) hallucinogenic agents affecting fetus or newborn via placenta or breast milk; 3) cocaine affecting fetus or newborn via placenta or breast milk; 4) alcohol affecting fetus or newborn via placenta or breast milk; and 5) drug withdrawal syndrome in newborns. We create rates of these outcomes using total birth counts by state and year from SEER data, making the outcomes equal to the percentage of total births in each of the ICD-9 categories. Implications for policy-making are discussed. We use a difference-in-difference model to investigate the effect of state-specific policies on prenatal substance use and consequences for newborn health.