Clinical Scorecard: Effects of Monthly Cash Transfers from the 2021 Expanded Child Tax Credit on Birth Outcomes in the United States: A Natural Experiment Analysis
At a Glance
Category
Detail
Condition
Adverse birth outcomes including small for gestational age (SGA) and low birth weight (LBW)
Key Mechanisms
Monthly cash transfers during pregnancy potentially improve birth outcomes by facilitating better nutrition, healthier behaviors, reducing financial stress, and improving mental health
Target Population
Pregnant individuals in the United States eligible for the 2021 expanded Child Tax Credit
Care Setting
Public health and prenatal care settings influenced by social safety net programs
Key Highlights
A $1000 increase in total pregnancy Child Tax Credit (CTC) payments was associated with a 0.72 percentage point decrease in small for gestational age births and a 0.49 percentage point decrease in low birth weight births.
The expanded CTC lifted 3.7 million children out of poverty and reduced childhood poverty by 30% by December 2021.
The association between CTC payments and improved birth outcomes was largest among non-Hispanic White individuals and smallest among foreign-born Hispanic individuals.
Guideline-Based Recommendations
Diagnosis
Use vital statistics birth certificate data to identify small for gestational age (<10th percentile weight for gestational age) and low birth weight (<2500 grams) infants.
Management
Consider the role of monthly cash transfer programs like the expanded Child Tax Credit as part of social interventions to improve birth outcomes.
Support policies that provide regular income support during pregnancy to reduce adverse birth outcomes.
Monitoring & Follow-up
Monitor birth outcomes with attention to socioeconomic factors and receipt of social safety net benefits including cash transfers.
Control for confounders such as COVID-19 pandemic effects and other concurrent social programs when evaluating birth outcomes.
Risks
Be aware that cash transfers alone may be insufficient to overcome all risk factors for adverse birth outcomes.
Recognize variability in impact across different racial and ethnic groups.
Patient & Prescribing Data
Pregnant individuals eligible for monthly Child Tax Credit payments during 2021
Monthly cash transfers during pregnancy are associated with moderate declines in adverse birth outcomes such as small for gestational age and low birth weight infants.
Clinical Best Practices
Incorporate social determinants of health, including income support programs, into prenatal care planning.
Advocate for continuation or implementation of regular cash transfer programs targeting pregnant individuals to improve maternal and infant health outcomes.
Use robust study designs controlling for temporal trends and confounders when assessing impacts of social policies on birth outcomes.
