Prenatal Substance Exposure and Reporting of Child Maltreatment By Race and Ethnicity

Background:Substance exposure is thought to contribute to reports of suspected maltreatment made to child protective services (CPS) at or shortly after birth. There are limited data, however, on whether clinicians are more likely to report black and Hispanic substance-exposed infants compared to white infants. This study examined the association between prenatal substance use and neonatal reporting of exposed infants to CPS. We used linked administrative records from California to determine the diagnosis of prenatal exposure and assess whether the discretion afforded to clinicians results in racial/ethnic disparities in the reporting of substance-exposed infants to CPS. We also explored how linked administrative records and standardized diagnostic codes can be used for population health monitoring of substance exposure and CPS responses.

Methods: We examined racial differences in diagnosed substance exposure and subsequent maltreatment reports using linked birth, hospital discharge, and CPS records. Diagnostic codes were used to document substance exposure; CPS records provided information on maltreatment reports. The prevalence of infant exposure was calculated by race/ethnicity, substance type, and sociodemographic covariates. To examine racial differences in CPS reporting among newborns exposed to substances, we estimated the relative risk (RR) and corresponding 95% confidence intervals (CI) using the delta method. We specified three generalized linear models with a Poisson distribution, log link, and robust standard error adjustments.

Results: Using a 2006 population-based California birth cohort of 474,071 black, Hispanic, and white infants, substance exposure diagnoses were identified for 1.6% of infants (n = 7,428). Exposure varied significantly across racial groups (p < .001), with the highest prevalence observed among black infants (4.1%) and the lowest among Hispanic infants (1.0%). Among white and Hispanic infants, the most prevalent substance types were amphetamine and cannabis; for black infants, cannabis was the most common, followed by cocaine. After adjusting for other sociodemographic and pregnancy factors, we found that substance exposed black and Hispanic infants were reported at significantly lower or statistically comparable rates to substance exposed white infants.

Conclusions: Prenatal substance exposure poses serious health risks for infants because of both the direct in utero impact on the developing fetus and the potential that ongoing parental substance abuse may place a newborn at risk of harm. Identifying exposed infants at birth allows medical providers to connect families to services that may offset health adversities and risks posed by ongoing substance abuse. Factors that contribute to CPS reporting decisions when substance exposure has been diagnosed are not well understood, and previous research has indicated racially biased responses. Although we were unable to address potential racial/ethnic disparities in diagnosing substances at birth, we found no evidence that racial disparities in infant CPS reports arise from variable responses to prenatal substance exposure.