Infant prenatal substance exposure and later child maltreatment in the US

Infants with prenatal substance exposure can have a number of health harms and their families need specialized services. Reforms to the Child Abuse Prevention and Treatment Act and passage of the Comprehensive Addiction and Recovery Act mandated procedures and services for infants with prenatal substance exposure. To (1) describe a national cohort of infants recorded as infants with prenatal substance exposure after federal reforms; and (2) assess the relationship with services provided at birth for any second confirmed maltreatment reports before age three years. Child Files in the US National Child Abuse and Neglect Data System for FY2018-2022. We first described the number of infants with prenatal substance exposure and the services they received during 2018-2020. We then identified second confirmed reports for these same children before age 3 years and assessed any relationship between recurrence and specific services using bivariate and multivariate regression models. Increasing numbers of infants were identified as prenatally substance exposed during FY2018-2020 and increasingly received more service referrals. An important proportion (14.3%) went on to have a second, confirmed child maltreatment report before age 3 years. Plans of Safe Care and services related to the Comprehensive Addiction and Recovery Act of 2016 were significantly associated with decreased later confirmed reports as were a small number of other services offered at birth. Services for infants with prenatal substance exposure are associated with fewer later child maltreatment reports. Further research is needed to examine longer term and other outcomes associated with these services. Increasing identification and service provision for mothers using substances during pregnancy can improve child outcomes during the first three years of life. • Infants with prenatal substance exposure can have a number of health harms and their families need specialized services. • Increasing numbers of infants were identified in the US as prenatally substance exposed during 2018-2020 • Many (14.3%) went on to have a second, confirmed child maltreatment report before age 3 years. • US mandates for CARA-related services were significantly associated with decreased later confirmed reports. Plans for Safe Care were not. • Increasing identification and service provision for mothers using substances during pregnancy can improve child outcomes during the first three years of life