Maternal Substance Abuse Diagnosed at Birth and Later Child Protective Service Involvement: A Birth Cohort Study
Objective. To estimate the population-prevalence of medically documented maternal substance use at birth and explore the corresponding rates of CPS-involvement.
Methods. This population-based birth cohort study is based on linked birth, hospital discharge, and CPS records from California. ICD-9-CM billing codes from hospital discharge records were used to classify all live births in 2006 based on whether or not there was documented maternal substance use. Generalized linear models were specified to examine the relationship between documented substance disorder and CPS-involvement, after adjusting for other factors.
Results. Among 551,232 infants born alive in 2006, 1.45% (n= 7,994) had a substance use disorder documented. Among births in which a substance use disorder was documented, 51.8% were reported to CPS during the first 3 days of life and 81.2% before age 1. After adjusting for other factors, a substance abuse disorder was associated with a fourfold increased risk for suspected maltreatment (RR: 5.25***; 95% CI: 5.09, 5.42). Notable variations emerged by substance type.
Conclusions. Medically documented substance use disorders were strongly associated with an infant’s likelihood of being reported to CPS. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a not uncommon pathway to CPS-involvement during infancy.
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Discuss how administrative data can be linked across systems. Describe the methodological power of prospective, birth cohort study designs. Explain how ICD-9-CM billing codes can be used to document substance exposure at birth.
Keyword(s): Child Abuse, Child Health Promotion
Qualified on the content I am responsible for because: I am the Director of the Children's Data Network and during the first 4 years of my post-doctoral career, have been the principal investigator on more than $3 million worth of research grants involving linked, administrative data. My research has been published in top public health journals, including the American Journal of Public Health, the American Journal of Epidemiology, and the Journal of Pediatrics. In 2014, I received the Commissioner's Award from ACYF.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.