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Peer-reviewedCC BY 4.0PLOS One

Prenatal substance exposure and 5-year child protection outcomes among infants not reported at birth

  • Julia Reddy1
  • Davida M. Schiff2
  • Anna Austin3
  • Hendree E. Jones4
  • Laura J. Faherty5
  • Rebecca Rebbe6
  • Anissa Vines7
  • Emily Putnam-Hornstein8
8 affiliations
  1. 1University of North Carolina Chapel Hill School of Social Work, Chapel Hill, North Carolina, United States of America
  2. 2MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts, United States of America
  3. 3Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
  4. 4Department of Obstetrics & Gynecology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
  5. 5RAND, Boston, Massachusetts, United States of America
  6. 6MaineHealth, Portland, Maine, United States of America
  7. 7Tufts University, Boston, Massachusetts, United States of America
  8. 8University of North Carolina Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Abstract

Discretionary child protection system (CPS) reporting policies allow some substance-exposed infants to be discharged from the hospital without a maltreatment report, but it is unknown whether risk for later system involvement varies according to exposure status. We conducted a retrospective cohort analysis of CPS involvement in the first 5 years of life as predicted by prenatal substance exposure among California births in 2018. At 5 years, less than 14% of exposed children experienced CPS reports of maltreatment harm or substantiated CPS reports. Exposed children were more likely to be reported for maltreatment harm at 5 years (adjusted Risk Difference (aRD)=0.03, 95%CI: 0.02, 0.04), including a subgroup with only cannabis exposure (aRD = 0.03, 95%CI: 0.02, 0.04) compared with unexposed infants. Prenatally exposed children were more likely to experience a substantiated report within 5 years compared with those without exposure (aRD = 0.03, 95%CI: 0.02, 0.03). Findings suggest that families affected by prenatal substance exposure who do not have apparent safety concerns at birth may benefit from support to prevent future instances of system intervention or child maltreatment.

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Cite

BibTeXRIS
BibTeX
@article{reddy2026prenatal,
  title = {{Prenatal substance exposure and 5-year child protection outcomes among infants not reported at birth}},
  author = {Julia Reddy and Davida M. Schiff and Anna Austin and Hendree E. Jones and Laura J. Faherty and Rebecca Rebbe and Anissa Vines and Emily Putnam-Hornstein},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357388},
  url = {https://doi.org/10.1371/journal.pone.0357388},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Prenatal substance exposure and 5-year child protection outcomes among infants not reported at birth
AU  - Julia Reddy
AU  - Davida M. Schiff
AU  - Anna Austin
AU  - Hendree E. Jones
AU  - Laura J. Faherty
AU  - Rebecca Rebbe
AU  - Anissa Vines
AU  - Emily Putnam-Hornstein
PY  - 2026
DA  - 2026/09/23
JO  - PLOS One
DO  - 10.1371/journal.pone.0357388
UR  - https://doi.org/10.1371/journal.pone.0357388
AB  - Discretionary child protection system (CPS) reporting policies allow some substance-exposed infants to be discharged from the hospital without a maltreatment report, but it is unknown whether risk for later system involvement varies according to exposure status. We conducted a retrospective cohort analysis of CPS involvement in the first 5 years of life as predicted by prenatal substance exposure among California births in 2018. At 5 years, less than 14% of exposed children experienced CPS reports of maltreatment harm or substantiated CPS reports. Exposed children were more likely to be reported for maltreatment harm at 5 years (adjusted Risk Difference (aRD)=0.03, 95%CI: 0.02, 0.04), including a subgroup with only cannabis exposure (aRD = 0.03, 95%CI: 0.02, 0.04) compared with unexposed infants. Prenatally exposed children were more likely to experience a substantiated report within 5 years compared with those without exposure (aRD = 0.03, 95%CI: 0.02, 0.03). Findings suggest that families affected by prenatal substance exposure who do not have apparent safety concerns at birth may benefit from support to prevent future instances of system intervention or child maltreatment.
SN  - 1932-6203
ER  -