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Updated: Jun 30, 2025

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Child Protection System Removal and Short-Interval Births Among Individuals With Prenatal Substance Use

Julia Reddy1, Davida Schiff, Mishka Terplan

  • 1Gillings School of Global Public Health, the Department of Obstetrics & Gynecology, and the School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts; and Friends Research Institute, Baltimore, Maryland.

Obstetrics and Gynecology
|March 14, 2024
PubMed

Child protection systems often intervene after substance-exposed births but are not designed to address the postpartum needs of the delivering parent. In this retrospective cohort study, we aimed to estimate the association between early child protection system removal and high-risk subsequent birth trajectories among a cohort of mothers with substance-exposed births in California. Of 6,893 births in 2015 with documented prenatal drug and alcohol exposure, 20.4% of mothers experienced child protection system removal within 30 days after birth. First-month child protection system removal was associated with short-interval birth (adjusted hazard ratio [HR] 1.61, 95% CI, 1.09-2.36) and short-interval birth with documentation of substance exposure (adjusted HR 3.17, 95% CI, 1.65-6.08). We found that child separation was associated with an increase, not a reduction, in subsequent substance-exposed births. These findings indicate the need for focused public health and supportive services to address the treatment, health care, family-building, and psychological needs of parents with substance use during pregnancy.

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