Substance use during pregnancy (or “prenatal substance use”) is becoming more common. Overdose and substance-related suicide are the leading preventable causes of maternal mortality, and prenatal substance use can increase the risk of miscarriage, birth defects, developmental disabilities, preterm birth, low birth weight, and decreased school readiness. State policy approaches to prenatal substance use vary widely, and mounting evidence indicates that treatment-oriented approaches are associated with better outcomes for children and families. This blog presents three categories of state policy approaches, with examples, and offers evidence on their effectiveness, based on available literature and correspondence with an addiction medication professional.
Broadly, states focus on 1) maximizing access to addiction treatment; 2) requiring health care providers to identify and, if needed, refer cases of prenatal substance use for treatment and/or child welfare involvement; or 3) immediately involving child welfare and/or law enforcement—or a mix of all three. The table below outlines example policies for each category and lists the number of states with each policy. Overall, state policy has increasingly turned to child welfare and law enforcement approaches to prenatal substance use. For example, three states now consider fetuses to be children, adding law enforcement implications for prenatal substance use.