Illicit drug use during pregnancy in states with and without punitive prenatal substance use policies.

Abstract

Introduction: An increasing number of states have implemented punitive prenatal substance use policies. These include policies that consider prenatal substance use as grounds for substantiating abuse and neglect or for terminating parental rights (i.e., child abuse policies) and policies that require healthcare professionals to report prenatal substance use to child protective services (i.e., mandated reporting policies). Little research has examined whether these policies reduce substance use during pregnancy. The aim of this study was to examine the association of punitive state prenatal substance use policies with illicit drug use during pregnancy.

Methods: Data from 19 states' 2016-2019 Pregnancy Risk Assessment Monitoring System (PRAMS) survey (N= 20,356) were used. Log-binomial regression with a generalized estimating equation approach was conducted to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing the likelihood of self-reported illicit drug use during pregnancy (i.e., marijuana, synthetic marijuana, heroin, amphetamines, cocaine or crack, tranquilizers, or hallucinogens) among pregnant women in states with and without a punitive prenatal substance use policy. Analyses were conducted in spring 2025.

Results: In multivariable analyses adjusted for potential confounders, the likelihood of illicit drug use during pregnancy did not differ between women in states with a punitive prenatal substance use policy and women in states without a punitive prenatal substance use policy (RR=1.02, 95% CI 0.93, 1.11).

Conclusions: Results indicate illicit drug use during pregnancy does not differ in states with and without punitive state prenatal substance use policies, suggesting that these policies do not reduce substance use during pregnancy.