Preventing and reducing alcohol use during pregnancy: Leveraging economic determinants and policies to inform health system interventions

About This Grant

While extensive research highlights how poverty can negatively impact health—including by increasing alcohol-related harms—little is known about how women’s economic experiences affect their use of alcohol and other substances around the time of pregnancy. This gap in the evidence is especially notable given that pregnancy is a high-risk period where any type of insecurity can have long-lasting implications. More than a quarter of U.S. births occur in families living below the poverty line, and half of pregnant women cite financial worries as a major source of stress. Low income is also a risk factor for fetal alcohol spectrum disorder (FASD) and numerous adverse birth outcomes that may involve stress-mediated alcohol use. Identifying how pregnancy-specific alcohol consumption patterns are influenced by sources of insecurity (e.g., food, housing, transportation, healthcare costs) is therefore a critical priority—with implications for screening, targeted prevention, and counseling in prenatal care, as well as other key healthcare system interventions. The objective of this K99/R00 proposal is to provide Dr. Emilie Bruzelius with the training and mentorship needed to begin investigating how economic stressors biologically and behaviorally mediate prenatal alcohol use and related birth outcomes. In the K99 phase, Aim 1 will first address a persistent methodological challenge—alcohol inaccurate reporting during pregnancy—by using biologically verified data from an external cohort (the HEALthy Brain and Child Development Study [HBCD]) to correct prenatal consumption estimates in two national surveys (the Pregnancy Risk Assessment Monitoring System [PRAMS] and the Behavioral Risk Factor Surveillance System [BRFSS]). Aim 2 will then use these corrected data to characterize trends by income and examine how specific domains contribute to observed patterns. In the R00 phase, Aims 3 and 4 will assess how insecurity changes, as proxied by access to refundable tax credits (Aim 3) and nutrition assistance (Aim 4)—are associated with differences in alcohol use patterns and related birth outcomes. Consistent with NIAAA’s priorities, these aims will contribute to our understanding of the factors influencing alcohol misuse during pregnancy to inform health systems strategies for improving pregnancy-related alcohol health. Complementing these research aims is a training plan that enhances the applicant’s background in epidemiologic methods and substance use health services research through new training in (1) perinatal alcohol epidemiology, neurodevelopment and FASD, (2) determinants of health, (3) advanced causal inference techniques, and (4) career development. This project will also lay the foundation for a future R01 application using the HBCD cohort to longitudinally examine how broad-based support programs can be better designed to support child health and neurodevelopment by addressing maternal substance use pathways. Collectively, these training and research activities, along with the support of an exceptional mentorship team, will prepare Dr. Bruzelius to launch an independent research career focused on improving alcohol-related health during pregnancy and across generations.