{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T09:51:43Z","timestamp":1777715503184,"version":"3.51.4"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01 AA023267"],"award-info":[{"award-number":["R01 AA023267"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["P50 AA005595"],"award-info":[{"award-number":["P50 AA005595"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec020\">\n<jats:title>Background<\/jats:title>\n<jats:p>Research has found that policies that single out pregnant people\u2019s alcohol consumption are mostly ineffective. Identifying alternative approaches \u2013 for example, general population alcohol policies \u2013 that can reduce adverse effects of pregnant people\u2019s alcohol consumption is essential. Here, we examine how U.S. state-level alcohol policies regarding grocery store and gas station sales, Sunday sales, Blood Alcohol Concentration limits for driving, and government monopolies relate to birth outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec021\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Outcome data came from the 1972\u20132019 U.S. Vital Statistics System birth certificates (N\u2009=\u2009160,538,939 live singleton births). Primary outcomes were low birthweight (&lt;2,500 grams) and preterm birth (&lt;37 weeks). Fully adjusted models included state and year fixed effects, state-specific time trends, and maternal- and state-level covariates with standard errors clustered by state.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec022\">\n<jats:title>Results<\/jats:title>\n<jats:p>The only significant, robust associations between policies and outcomes were for government monopolies. In fully adjusted models, having a government monopoly on spirits or on both spirits and wine retail sales (vs. none) were each related to lower odds of low birthweight births (aOR=0.94, 95% CI: 0.93, 0.95; aOR=0.95, 95% CI: 0.92, 0.98 respectively). Having a government monopoly on spirits sales was also significantly related to lower odds of preterm births (aOR=0.97, 95% CI: 0.95, 1.00).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec023\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Government monopolies on spirits and wine relate to better birth outcomes. Findings underscore the importance of maintaining state government monopolies on spirits and wine as a strategy for protecting against adverse effects of pregnant people\u2019s drinking.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0327559","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T17:27:32Z","timestamp":1754328452000},"page":"e0327559","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationships between state-level general population alcohol policies and birth outcomes: Results from 1972\u20132019 vital statistics"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1336-7552","authenticated-orcid":true,"given":"Meenakshi S.","family":"Subbaraman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5310-4848","authenticated-orcid":true,"given":"Nancy F.","family":"Berglas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C.","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7732-4607","authenticated-orcid":true,"given":"Sarah C. 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