The impact of the 2021 Child Tax Credit on perinatal health: Evidence from the Expansion and Post-expiration Periods

INTRODUCTION: The perinatal period is a pivotal life stage that profoundly influences lifelong health and well-being. In 2021, the U.S. temporarily expanded the Child Tax Credit (CTC), providing monthly payments during July-December 2021 and the remaining lump-sum payment during the 2022 tax season. This study examines the impact of the 2021 expansion on perinatal health among low-income families. METHODS: Data were drawn from national birth certificate data (January 2021-December 2022) and were restricted to women covered by Medicaid, who are likely to be low-income. A quasi-experimental event-study design was used to compare perinatal outcomes over time between women with and without previous live births, who had different exposure patterns to the 2021 expansion. (N=2,485,813). Analyses were conducted January-May 2025. RESULTS: The CTC expansion was associated with increased appropriate-for-gestational-age births and decreased small-for-gestational-age and large-for-gestational-age births. Effects were most pronounced immediately after expiration of monthly payments (1.17 percentage points; 95%CI: 0.45, 1.88)-potentially reflecting the cumulative impact of six months of income support-and several months after the lump-sum distributions, waning by the end of 2022. For maternal outcomes, an increased likelihood of hypertensive disorders of pregnancy and a decreased likelihood of no/late prenatal care were observed during the monthly payments period and persisting through the end of 2022. Sensitivity analyses supported the robustness of findings. CONCLUSIONS: These results suggest that the expanded CTC had positive effects on certain perinatal outcomes among low-income families, highlighting the potential of income support policies to reduce health inequities during a critical life stage and informing policymaking.