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Pregnancy and Alcohol: Warning Signs: Drinking During Pregnancy

Laws that require warning signs be posted in settings where alcoholic beverages are sold and health care facilities where pregnant women receive treatment.

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Expander Policy Description

(Period Covered: 1/1/2003 through 1/1/2016)

This policy topic covers laws that require warning signs be posted in settings where alcoholic beverages are sold and health care facilities where pregnant women receive treatment.  

Scientific research has established that alcohol consumption during pregnancy is associated with adverse health consequences.  Fetal Alcohol Spectrum Disorders (FASD) is the term used to describe the range of birth defects caused by maternal alcohol consumption during pregnancy.  FASD are considered the most common nonhereditary cause of mental retardation.  Included in Fetal Alcohol Spectrum Disorders is the diagnosis often referred to as Fetal Alcohol Syndrome (FAS), which is the most severe form of FASD. It is characterized by facial defects, growth deficiencies, and central nervous system dysfunction.  Also included in FASD are other types of alcohol-induced mental impairments that are just as serious, if not more so, than in children with FAS.  The term "alcohol-related neurodevelopmental disorder" (ARND) has been developed to describe such impairments. Prenatally exposed children can also have other alcohol-related physical abnormalities of the skeleton and certain organ systems; these are known as alcohol-related birth defects (ARBD). (National Institute on Alcohol Abuse and Alcoholism, June 2000; Warren and Foudin, 2001; SAMHSA, 2004). 

State and Federal governments have established various policies in response to the risks associated with drinking during pregnancy.  This section describes policies requiring that warning signs be posted in settings such as licensed premises where alcoholic beverages are sold and health care facilities where pregnant women receive treatment.  Policy provisions specify who must post signs, the specific language required on the signs, and where signs must appear.  The warning language required across jurisdictions varies in detail, but in each case, it warns of the risks associated with drinking during pregnancy. 


State policies mandating warning signs should be distinguished from the Federal law that requires health warning labels on alcohol containers, which include a warning against drinking during pregnancy because of the risk of birth defects (see Federal Law).


Expander Explanatory Notes and Limitations for Pregnancy and Alcohol: Warning Signs: Drinking During Pregnancy

Explanatory Notes and Limitations Specifically Applicable to Pregnancy and Alcohol: Warning Signs: Drinking During Pregnancy

  1. In some jurisdictions, display requirements of gender neutrality apply to the language of signs. Specific requirements that may impinge on gender neutrality, e.g., a requirement that signs be posted in women's public restrooms, are recorded in the Row Notes or Jurisdiction Notes for relevant States.
  2. The following establishments or settings are not addressed in the APIS analysis of mandatory warning signs relating to drinking during pregnancy:
    • Hotel minibars
    • Racetracks, fairgrounds, or sports stadiums
    • Special event type permits
    • Banquet and catering facilities and services
    • Trains, airlines (including airport lounges), boats, limousines, or other public transportation
    • Private clubs (e.g., country clubs and fraternal or veterans' organizations); for Utah and West Virginia, however, this analysis does include establishments nominally designated as "private," since these establishments (together with licensed restaurants in Utah) are the primary on-sale retail alcohol outlets in those states
    • University campuses

Explanatory Notes and Limitations Applicable to All APIS Policy Topics 

  1. State law may permit local jurisdictions to impose requirements in addition to those mandated by State law. Alternatively, State law may prohibit local legislation on this topic, thereby preempting local powers. For more information on the preemption doctrine, see the About Alcohol Policy page. APIS does not document policies established by local governments. 
  2. In addition to statutes and regulations, judicial decisions (case law) also may affect alcohol-related policies. APIS does not review case law except to determine whether judicial decisions have invalidated statutes or regulations that would otherwise affect the data presented in the comparison tables. 
  3. APIS reviews published administrative regulations. However, administrative decisions or directives that are not included in a State's published regulatory codes may have an impact on implementation. This possibility has not been addressed by the APIS research. 
  4. Statutes and regulations cited in tables on this policy topic may have been amended or repealed after the specific date or time period specified by the site user's search criteria. 
  5. If a conflict exists between a statute and a regulation addressing the same legal issue, APIS coding relies on the statute. 
  6. A comprehensive understanding of the data presented in the comparison tables for this policy topic requires examination of the applicable Row Notes and Jurisdiction Notes, which can be accessed from the body of the table via links in the Jurisdiction column. 

Expander Federal Law for Pregnancy and Alcohol: Warning Signs: Drinking During Pregnancy

(Policies in effect on: 1/1/2016)

Although Federal statutes mandate health warning labels on all alcoholic beverage containers (see Alcoholic Beverage Labeling Act of 1988, 27 U.S.C. § 213, et seq.), our research identified no Federal statutes or regulations requiring alcohol retailers or health care providers to post signs warning against the risks of drinking during pregnancy.

Expander Selected References for Pregnancy and Alcohol: Warning Signs: Drinking During Pregnancy

  1. Andrews, J.C. The effectiveness of alcohol warning labels – A review and extension. American Behavioral Scientist 38(4):622-632, 1995.
  2. Drabble L, Thomas S, O’Connor L, and Roberts SM. State responses to alcohol use and pregnancy: Findings from the Alcohol Policy Information System. Journal of Social Work Practice in the Addictions, 14(2):191-206, 2014.
  3. Floyd, R.L., Ebrahim, S., Tsai, J., O'Connor, M., and Sokol, R. Strategies to reduce alcohol-exposed pregnancies. Maternal and Child Health Journal 10(5):149-151, 2006.
  4. Golden, J. Message in a Bottle: The Making of Fetal Alcohol Syndrome. Cambridge: Harvard University Press, 2005.
  5. Hankin, J.R., Sloan, J.J., Firestone, I.J., Ager, J.W., Sokol, R.J., and Martier, S.S. Has awareness of the alcohol warning label reached its upper limit? Alcoholism: Clinical & Experimental Research 20(3):440-4, 1996.
  6. Jones, K.L., and Streissguth, A.P. Special issue introduction: Fetal alcohol syndrome and fetal alcohol spectrum disorders: A brief history. Journal of Psychiatry & Law 38(4):373-38, 2010.
  7. Kaskutas, L., and Greenfield, T.K. First effects of warning labels on alcoholic beverage containers. Drug & Alcohol Dependence 31(1):1-14, 1992.
  8. Substance Abuse and Mental Health Services Administration, Center for Excellence. Fetal Alcohol Spectrum Disorders (FASD). Accessed August 9, 2012 at: http://fasdcenter.samhsa.gov/.
  9. Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Substance Use Among Women During Pregnancy and Following Childbirth. Rockville, MD: The National Survey on Drug Use and Health Report, 2009.
  10. Thomas, S., Cannon, C., and French, J. (2015). The effects of state alcohol and pregnancy policies on women’s health and healthy pregnancies. Journal of Women, Politics & Policy 36(1), 68-94. DOI:10.1080/1554477X.2015.985153. Retrieved from http://www.tandfonline.com/doi/full/10.1080/1554477X.2015.985153 .
  11. Thomas, S., Rickert, L., and Cannon, C. The meaning, status, and future of reproductive autonomy: The case of alcohol use during pregnancy. UCLA Women’s Law Journal 15:1-46, 2006.
  12. Warren, K.R., Hewitt, B.G., and Thomas, J.D. Fetal alcohol spectrum disorders: Research challenges and opportunities. Alcohol Research & Health 34(1):4-14, 2011.
  13. Young, N.K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., and Amatetti, S. Substance-Exposed Infants: State Responses to the Problem. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2008.

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