Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. For this first-of-its-kind analysis, we negotiated permissions to connect birth, hospital discharge, and CPS records from California. We then used those linked records to estimate the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. In addition, we explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors.

Among 551,232 infants born alive in 2006, 1.45% (n =7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant’s likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS involvement was observed by substance type. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a common pathway to CPS involvement during infancy, and can act as a model for future work that leverages these data for population health surveillance. Future research is needed to explicate the longer-term trajectories of infants diagnosed with prenatal substance exposure, including the role of CPS.