How Prenatal Substance Use Laws Inadvertently Endanger Healthy Families

Authors

Stacey McKenna

Resident Senior Fellow, Integrated Harm Reduction

Courtney Joslin

Resident Fellow and Senior Manager, Project for Women and Families

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Download the PDF of this explainer.

This explainer is designed to accompany the policy study, “Prenatal Substance Use Laws Inadvertently Endanger Healthy Families: A Review of Laws Affecting Pregnant Women in Recovery and Their Children.”

Risks of Untreated Opioid Use Disorder (OUD) During Pregnancy

Between 2017 and 2020, about 16 percent of deaths during pregnancy or the postpartum period were overdose-related.

Untreated OUD is associated with:

• Lack of prenatal care
• Increased risk of stilbirth
• Increased risk of preterm labor
• Risk of neonatal opioid withdrawal syndrome
• Various other complications

Approximately one-third of children in foster care are there because of parental drug use, including during pregnancy.

Medications for Opioid Use Disorder (MOUD) Improve Outcomes for Both Child and Mother

Benefits to mother:

• Reduce cravings and withdrawal symptoms
• Reduced overdose risk
• Improve treatment retention
• Reduce use of illegal drugs
• Increased likelihood of continuing treatment after birth
• Family more likely to stay together

Benefits to Fetus/Child:

• Reduced risk of preterm birth
• Reduced risk of low birth weight
• More well-child visits
• Lower risk of hospital readmission
• Family more likely to stay together

Harms Associated with Policies Penalizing Prenatal Drug Use

To Fetus/Infant:

• Lower birth weight
• Younger gestational age
• Lower Apgar scores
• Increased risk of stillbirth
• Increased risk of mortality
• Greater risk of neonatal abstinence syndrome
• Suboptimal prenatal care

To Mother:

• Increased risk of overdose
• Increased risk of mental health issues
• Reduced rates of OUD treatment engagement and motivation
• Suboptimal prenatal care

Despite the benefits of MOUD and the harms of penalizing prenatal substance use, pregnant women taking these prescribed medications risk criminal charges and custody loss.

• Between 2016 and 2024, nearly 3,700 women in eight states and Washington, D.C. were reported to child protective services (CPS) solely for taking a prescribed medication for OUD while pregnant.
• From 2022 to 2023, at least 16 women were criminally charged for taking MOUD during pregnancy.