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Published on: February 28, 2025
Prenatal cannabis exposure and the risk of subsequent maltreatment
Joseph P Ryan1, Lauren Oshman2, Christopher J Frank2
1University of Michigan School of Social Work, United States of America.
Insights
Racial bias in newborn drug testing is evident, with Black and multiracial infants more likely to be tested. Prenatal cannabis exposure did not increase the risk of child maltreatment following policy changes.
Area of Science:
- Perinatal health
- Child welfare
- Public health policy
Background:
- Parental substance use is a known risk factor for child maltreatment.
- Racial disparities exist in child protective services investigations.
- Prenatal exposure to substances, including cannabis, raises concerns for infant safety.
Purpose of the Study:
- To evaluate racial bias in newborn drug testing practices.
- To examine the association between prenatal tetrahydrocannabinol (THC) exposure and subsequent child maltreatment.
- To assess the impact of a policy change on drug testing and maltreatment investigations.
Main Methods:
- Retrospective cohort study linking hospital birth and child maltreatment data (n=35,437).
- Defined prenatal THC exposure via positive newborn meconium drug tests.
- Analyzed substantiated Child Protective Services (CPS) reports before and after a 2018 policy change regarding THC investigations.
Main Results:
- Black and multiracial newborns were significantly more likely to undergo substance exposure testing at birth.
- Newborns testing positive only for THC were not at higher risk for maltreatment post-policy change compared to negative or untested infants.
- Regression analyses identified racial disparities in newborn drug testing.
Conclusions:
- Evidence supports ending routine CPS investigations for cannabis exposure.
- Eliminating racially biased drug testing practices in newborns is recommended.
- Policy changes can mitigate disparities in child welfare investigations related to substance exposure.
Background:
Parental substance use can increase the risk of child maltreatment.
Objective:
The purpose of this study was to assess racial bias in newborn drug testing and to investigate the association between prenatal tetrahydrocannabinol (THC) exposure and subsequent child maltreatment.
Participants And Setting:
This retrospective cohort study (n = 35,437) linked University of Michigan Hospital birth data and Michigan Department of Health and Human Services child maltreatment data relative to a 2018 policy change. Prior to 2018, prenatal THC exposure was routinely substantiated as physical abuse; after 2018 THC exposure was investigated but not automatically substantiated.
Methods:
We defined prenatal THC exposure as a positive newborn meconium drug test for THC. The primary outcome was a substantiated Child Protective Services (CPS) report of maltreatment before and after the policy change. Demographic variables included parent age, race, ethnicity, zip code and insurance type. Covariates included prenatal urine drug test orders and results, and newborn drug test orders and results. Regression models estimated the rate of subsequent maltreatment and racial disparities associated with newborn testing.
Results:
Regression analyses indicated that Black and multiracial newborns were significantly more likely to be tested for substance exposure at birth. Newborns with a test positive for THC only were not more likely to experience maltreatment after the policy change as compared with newborns that tested negative and newborns not tested.
Conclusions:
The evidence strongly supports a policy to end routine CPS investigations for cannabis exposure and eliminate racially biased drug testing practices.
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