Introduction:

The data for the Pregnancy and Drug Use policy topics were developed as part of a research project headed by Dr. Sarah CM Roberts, Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. The project was funded by grants from the National Institute on Alcohol Abuse and Alcoholism (#R01AA023267) and the University of California, San Francisco, California Preterm Birth Initiative, funded by Marc and Lynne Benioff.

The Pregnancy and Drug Use Policy Dataset consists of six policy topics that mirror the Pregnancy and Alcohol policy topics on APIS:

• Civil commitment policies pertain to mandatory involuntary commitment of a pregnant woman to treatment or mandatory involuntary placement in protective custody of the state for the protection of a fetus from prenatal exposure to drugs.
• Mandatory warning signs require that notices about cannabis use during pregnancy are posted in medical/recreational marijuana dispensaries. The warning language must warn of the risk associated with using cannabis while pregnant.
• Priority treatment mandates priority access to substance abuse treatment for pregnant and postpartum women who use drugs.
• Prohibitions against criminal prosecution prohibits use of the results of medical tests, such as prenatal screenings or toxicology tests, as evidence in the criminal prosecutions of women who may have caused harm to a fetus or an infant.
• Reporting requirements are mandated or discretionary reporting of suspicion of or evidence of drug use or abuse by women during pregnancy to agencies such as law enforcement, social services, and health services. Evidence may consist of screening and/or toxicological testing of pregnant women or toxicological testing of infants after birth, and reporting may be for child abuse/neglect investigation, provision of health services, or for data gathering purposes.
• Child abuse/child neglect refers to the legal significance of a woman’s conduct prior to birth and of damage caused in utero and, in some cases, defines drug use during pregnancy as child abuse or neglect.

Data Gathering Process:

The “Roberts” data range from 1968–2017. Data were gathered in a two-step research process as follows:

• Because pregnancy and alcohol statutes and regulations across U.S. jurisdiction overlap substantially (although not completely; see Thomas et al., 2018), project staff started the Pregnancy and Drug dataset with all relevant citation data (statutes and regulations that addressed both alcohol and drugs) from all six APIS Pregnancy and Alcohol policy topics in 2017 and traced each citation back to its original effective date. Data for all amendments or recodifications to statutes and regulations that occurred from 1968 to 2017 were also gathered and included in the dataset.
• Using, Westlaw¹, HeinOnline², and StateScape³, additional searches for statutes and regulations pertaining to the six Pregnancy and Drug Use policy topics were run for all 51 jurisdictions (50 States and the District of Columbia). That is, searches were conducted to locate statutes and regulations pertaining to drugs, but not to alcohol. This original round of drug-specific research sought to identify policies in effect as of January 1, 2017. Each identified statute and regulation was tracked back in time to the effective date for that policy in that jurisdiction – and any changes that occurred within the 49-year time frame.

¹ Westlaw is an online legal research tool that features information on state and federal statutes, administrative codes (regulations), case law, law journals and other legal resources.

² HeinOnline is a legal database containing titles of historical and government documents.

³ StateScape provides information on effective dates practices in all jurisdictions. So, for example, if a statute notes that its effective date is 30 days after the end of a legislative session, StateScape displays information on the beginning and end of legislative sessions per jurisdiction. These data allow legal policy researchers to calculate effective dates when they are not directly provided in statutes.  

Additional Legal Research Context:

1. The legal research protocol used by staff members on the Roberts project was as follows: one legal researcher performed the research work on States with names in the first half of the alphabet as the other legal researcher performed legal research on the second half of the alphabet. Then, the researchers exchanged the data and performed independent quality control steps to validate the coding. Researchers worked together to reach consensus when independent findings diverged. When available, secondary sources were used to compare the original data collection to the data from other sources. In this case, publicly-available Guttmacher data were the most useful secondary data collections. See: https://www.guttmacher.org/state-policy/explore/substance-use-during-pr… .

2. For data gathering on statutes and their original effective dates as well as all amendments to statutes within the 49 year time frame, staff members used the online legal research tools:  Westlaw, HeinOnline, and Statescape. For data gathering on regulations, staff relied on Westlaw as well as general internet searches, as other legal research tools do not address regulatory enactments. This means that tracking original effective dates of regulations is more difficult than for statutes. Still, using all available methods, staff were able to locate original effective dates for all but a very small number of regulations.            

3. One important caveat to this research process is that there is a possibility that a jurisdiction may have enacted a statute or regulation on drug use during pregnancy and then repealed it before 1/1/2017. If this is the case, then it is possible that any such statute or regulation would not be included in this dataset.

Substantive References:

Drug Use During Pregnancy Policies in the United States From 1970 to 2016. Contemporary Drug Problems. 2018 Dec 1; 45(4):441-459. Sue Thomas, Ryan Treffers, Nancy F. Berglas, Laurie Drabble, Sarah C. M. Roberts.

Forty Years of State Alcohol and Pregnancy Policies in the USA: Best Practices for Public Health or Efforts to Restrict Women's Reproductive Rights? Alcohol Alcohol. 2017 Nov 01; 52(6):715-721. Roberts SCM, Thomas S, Treffers R, Drabble L. PMID: 29016712.

Associations Between State-Level Policies Regarding Alcohol Use Among Pregnant Women, Adverse Birth Outcomes, and Prenatal Care Utilization: Results from 1972 to 2013 Vital Statistics. Alcohol Clin Exp Res. 2018 Jun 18. Subbaraman MS, Thomas S, Treffers R, Delucchi K, Kerr WC, Martinez P, Roberts SCM. PMID: 29912478.

Differential Effects of Pregnancy-Specific Alcohol Policies on Drinking Among Pregnant Women by Race/Ethnicity. Health Equity. 2018; 2(1):356-365. Roberts SCM, Mericle AA, Subbaraman MS, Thomas S, Treffers RD, Delucchi KL, Kerr WC. PMID: 30560228.

Estimating the Prevalence of United States Women with Alcohol-exposed Pregnancies and Births. Women’s Health Issues. 2019 Mar - Apr; 29(2):188-193. Roberts SCM, Thompson KM. PMID: 30651200.

State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985-2016: Evidence from the Behavioral Risk Factor Surveillance System. Women’s Health Issues. 2019 May - Jun; 29(3):213-221. Roberts SCM, Mericle AA, Subbaraman MS, Thomas S, Treffers RD, Delucchi KL, Kerr WC. PMID: 30876695.

"Alcohol During Pregnancy? Nobody Does That Anymore": State Legislators' Use of Evidence in Making Policy on Alcohol Use in Pregnancy. J Stud Alcohol Drugs. 2019 05; 80(3):380-388. Woodruff K, Roberts SCM. PMID: 31250804.

Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study. Drug Alcohol Depend. 2019 08 01; 201:244-252. Roberts SCM, Berglas NF, Subbaraman MS, Mericle A, Thomas S, Kerr WC. PMID: 31255852.

Variations by Education Status in Relationships Between Alcohol/Pregnancy Policies and Birth Outcomes and Prenatal Care Utilization: A Legal Epidemiology Study. J Public Health Manag Pract. 2020 Mar/Apr; 26 Suppl 2, Advancing Legal Epidemiology:S71-S83. Roberts SCM, Mericle AA, Subbaraman MS, Thomas S, Kerr W, Berglas NF. PMID: 32004225.

Costs Associated with Policies Regarding Alcohol Use during Pregnancy: Results from 1972-2015 Vital Statistics. (2019). PloS one, 14(5), Subbaraman, M. S., & Roberts, S. C. e0215670.

Methodological References (How to collect legal data for use in social science research):

Anderson, E.D., Thomas, S., Treffers, R.D., & Wagenaar, A.C. (2023). Measuring Statutory Law and Regulations for Empirical Research. In Alexander C. Wagenaar, Rosalie Licardo Pacula, Scott Burris (Eds.): Legal Epidemiology: Theory and Methods, 2^nd Edition. Jossey-Bass.

Tremper, C., Thomas, S., & Wagenaar, A.C. (2010). Measuring Law for Evaluation Research. Evaluation Review, 34:242-66.

Period Covered: 1/1/1968 through 1/1/2025

This policy topic covers laws addressing involuntary civil commitment of pregnant drug abusers to treatment or involuntary placement in protective custody of the State for the protection of a fetus from prenatal exposure to drugs.

Scientific research has shown that many drugs, both licit and illicit, when consumed during pregnancy, may result in miscarriage, premature birth, low birth weight, and behavioral and cognitive problems in infants. An infant may also be born dependent on certain drugs (Wendell, 2013).

State and Federal governments have established various policies in response to the risks associated with drug use during pregnancy. This section of APIS addresses involuntary civil commitment of pregnant drug abusers. Civil commitment refers either to involuntary civil commitment of a pregnant woman to treatment or involuntary placement of a pregnant woman in protective custody of the State for the protection of a fetus from prenatal exposure to drugs. As of January 1, 2017, five jurisdictions had statutory authorization for the civil commitment of women who abuse drugs during pregnancy: Minnesota, North Dakota, Oklahoma, South Dakota, and Wisconsin.

There are two types of civil commitments: emergency and judicial. Emergency commitments are short in duration and may be imposed by the administrator of an appropriate mental health facility. Emergency commitment laws are not included in this research or in the coding of this policy topic except as described in this policy description. Judicial commitments are typically lengthier and must be ordered by a court.

The involuntary civil commitment arrangements in North Dakota, Oklahoma, and South Dakota provide for committing pregnant drug abusers to treatment facilities. The procedures in those three States are similar, as shown in the first table below.

Minnesota provides two types of civil commitment procedures: early intervention and judicial commitment. Early intervention is of shorter duration and involves a less intrusive program than the standard judicial commitment procedure.

Wisconsin's child welfare laws provide for involuntary civil commitment to a variety of placements including a treatment facility, jail, and a relative's home. In Wisconsin there are three stages leading to a judicial commitment. In the first stage, a woman is taken into protective custody, usually by law enforcement or child protective services. In the second stage, in cases in which there is a substantial health risk to the fetus, the woman may be held (detained) in protective custody for up to 48 hours. In the third stage, if custody is sought for a sustained period of time (i.e., a period longer than provided for in the second stage), the woman is entitled to legal representation and a hearing at which a court determines whether it will enter an order for her continued custody.

Despite their differences, all of these commitment and custody provisions are designed to protect the fetus via the involuntary restriction of the pregnant woman's action or conduct. The tables below present key characteristics of civil commitment and custody procedures in each of the five States where they existed as of January 1, 2017.

MINNESOTA, NORTH DAKOTA, OKLAHOMA, SOUTH DAKOTA: ELEMENTS OF CIVIL COMMITMENT

WISCONSIN: THREE STAGES OF CUSTODY

Stage 1: Taking Person into Physical Custody

Stage 2: Holding a Person Briefly in Custody

Stage 3: Continued Physical Custody

Explanatory Notes and Limitations Specifically Applicable to Pregnancy and Drugs: Civil Commitment

1. APIS collects legal provisions that either specifically refer to "prenatal substance abuse," "prenatal drug abuse" or to a condition that reasonably may be interpreted as referring to drug abuse (e.g., "substance abuse," "addictive drug," "drug of abuse").
2. There is a possibility a jurisdiction may have enacted a statute or regulation on drug use during pregnancy and then repealed it before 1/1/2017.  If this is the case, then it is possible that any such statute or regulation would not be included in this dataset. (Please see the "Overview of Pregnancy and Drugs Policy Topics," above, for more information.)

Explanatory Notes and Limitations Applicable to All APIS Policy Topics

1. State law may permit local jurisdictions to impose requirements in addition to those mandated by State law. Alternatively, State law may prohibit local legislation on this topic, thereby preempting local powers. For more information on the preemption doctrine, see the About Alcohol Policy page. APIS does not document policies established by local governments.
2. In addition to statutes and regulations, judicial decisions (case law) also may affect alcohol-related policies. APIS does not review case law except to determine whether judicial decisions have invalidated statutes or regulations that would otherwise affect the data presented in the comparison tables.
3. APIS reviews published administrative regulations. However, administrative decisions or directives that are not included in a State's published regulatory codes may have an impact on implementation. This possibility has not been addressed by the APIS research.
4. Statutes and regulations cited in tables on this policy topic may have been amended or repealed after the specific date or time period specified by the site user's search criteria.
5. The operation or enforcement of statutes or regulations affecting the policies addressed on APIS may have been suspended or modified by executive or administrative orders issued in response to the COVID-19 pandemic. With the exception of the COVID-19 Digest and Dataset, APIS research does not address these orders or the effects they may have on the policies covered by APIS.
6. Policy changes in APIS are presented as of the date these changes take effect as law. Users should be aware that in some situations there may be a delay between the effective date of a law and the time a corresponding policy change occurs in practice. Because APIS research is based entirely on primary legal source materials (codified statutes and regulations and, on rare occasions, published court opinions), APIS is unable to accurately determine when policy changes may appear in practice.
7. If a conflict exists between a statute and a regulation addressing the same legal issue, APIS coding relies on the statute.
8. A comprehensive understanding of the data presented in the comparison tables for this policy topic requires examination of the applicable Row Notes and Jurisdiction Notes, which can be accessed from the body of the table via links in the Jurisdiction column.

(Policies in effect on: 1/1/2025)

Our research identified no Federal statutes or regulations pertaining to involuntary civil commitment of pregnant women who may have exposed a fetus to drugs.

1. Abel, E.L., and Kruger, M. Physician attitudes concerning legal coercion of pregnant alcohol and drug abusers. American Journal of Obstetrics & Gynecology 186(4):768-772, 2002.
2. American Academy of Pediatrics. (2013). AAP describes damaging effects of substance abuse on the developing fetus. Retrieved March 27, 2018, from https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAPDescrib…
3. American Congress of Obstetricians and Gynecologists. (2011). Substance abuse reporting and pregnancy: The role of the obstetrician–gynecologist. Committee Opinion No. 473. Obstetrics & Gynecology, 117, 200–201.
4. American Society of Addiction Medicine. (2011). Public policy statement on women, alcohol and other drugs, and pregnancy. Retrieved March 27, 2018, from https://www.asam.org/docs/public-policy-statements/1womenandpregnancy_7…
5. Angelotta, C., & Appelbaum, P. S. (2017). Criminal charges for child harm from substance use in pregnancy. Journal of the American Academy of Psychiatry and the Law, 45, 193–203.
6. Atkins, D. N., & Durrance, C. P. (2021). The impact of state-level prenatal substance use policies on infant foster care entry in the United States. Children and Youth Services Review, 130, 106194.
7. Atkins, D. N., & Durrance, C. P. (2020). State Policies That Treat Prenatal Substance Use As Child Abuse Or Neglect Fail To Achieve Their Intended Goals: Study examines the effect of state policies that treat prenatal substance use as child abuse or neglect on the incidence of neonatal abstinence syndrome and other factors. Health Affairs, 39(5), 756-763.
8. Bandara, S., Schall, T. E., White, S. A., McCourt, A. D., Goodman, D., & McGinty, E. E. (2022). Association between US state prenatal drug use laws and child welfare reporting in Alabama, Maryland and Utah. International Journal of Drug Policy, 108, 103806.
9. Barnett, E. R., Knight, E., Herman, R. J., Amarakaran, K., & Jankowski, M. K. (2021). Difficult binds: A systematic review of facilitators and barriers to treatment among mothers with substance use disorders. Journal of Substance Abuse Treatment, 126, 108341.
10. Bishop, D., Borkowski, L., Couillard, M., Allina, A., Baruch, S., & Wood, S. (2017). Bridging the divide white paper: Pregnant women and substance use: Overview of research & policy in the United States. Retrieved March 27, 2018, from The George Washington University, Jacobs Institute of Women’s Health website: https://hsrc.himmelfarb.gwu.edu/sphhs_centers_jacobs/5
11. Campbell, N. (2002). Using women: Gender, drug policy, and social justice. Abingdon, England: Routledge.
12. Carroll, J. J., El-Sabawi, T., & Ostrach, B. (2021). The harms of punishing substance use during pregnancy. International Journal of Drug Policy, 98, 103433.
13. Centers for Disease Control and Prevention. (2016a). An alcohol-free pregnancy is the best choice for your baby. Retrieved from https://www.cdc.gov/ncbddd/fasd/documents/fasdbrochure_final.pdf. Accessed on March 27, 2018.
14. Cerdá, M., & Krawczyk, N. (2020). Pregnancy and access to treatment for opioid use disorder. JAMA Network Open, 3(8), e2013899-e2013899.
15. Chang, G. (2020). Maternal Substance Use: Consequences, Identification, and Interventions. Alcohol Research: Current Reviews, Vol. 40 No. 2, Epub, 2020 June 25.
16. Chasnoff, I. J., Landress, H. J., & Barrett, M. E. (2012). The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. New England Journal of Medicine, 322, 1202–1206. doi:10.1056/NEJM199004263221706
17. Chavkin, W. (1991). Mandatory treatment for drug use during pregnancy. The Journal of the American Medical Association, 266, 1556–1561. doi:10.1001/jama.1991.03470110102041
18. Conner, S. N., Bedell, V., Lipsey, K., Macones, G. A., Cahill, A. G., & Tuuli, M. G. (2016). Maternal marijuana use and adverse neonatal outcomes: A systematic review and meta-analysis. Obstetrics and Gynecology, 128,713–723.
19. Corsi DJ, Walsh L, Weiss D, et al. Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes. JAMA. Published online June 18, 2019 322(2):145–152. doi:10.1001/jama.2019.8734
20. Dailard, C., & Nash, E. (2000). State responses to substance abuse among pregnant women. The Guttmacher Report on Public Policy, 3, 3–6.
21. Deutsch, A. R., Jalali, M. S., Stout, S., & Frerichs, L. (2024). Equitable policies need equitable practices: alcohol-and substance-exposed pregnancy as a case study. Health promotion practice, 25(1), 17-21. 
22. England, L.J., Bennett, C., Denny, C.H., Honein, M.A., Gilboa, S.M., Kim, S.Y., Guy, G.P., et al. (2020). Alcohol use and co-use of other substances among pregnant females aged 12–44 years—United States, 2015–2018. Morbidity and Mortality Weekly Report 69(31): 1009.
23. English, F., & Greyson, D. (2022). “You still have that fear”: Policy constraints on informed decision making about legalized cannabis use during pregnancy and lactation. International Journal of Drug Policy, 106, 103774.
24. Faherty, L.J., Stein, B.D., and Terplan, M. (2020). Consensus guidelines and state policies: The gap between principle and practice at the intersection of substance use and pregnancy. American Journal of Obstetrics & Gynecology MFM 2(3): 100137.
25. Gehshan, S. (1995). Missed opportunities for intervening in the lives of pregnant women addicted to alcohol or other drugs. Journal of the American Medical Women’s Association (1972), 50, 160–163.
26. Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. The Lancet, 371, 75–84.
27. Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 2000;22(3):325-336.
28. Gopman, S. (2014). Prenatal and postpartum care of women with substance use disorders. Obstetrics and Gynecology Clinics of North America, 41(2), 213–228. https://doi.org/10.1016/j.ogc.2014.02.004
29. Gupta, P. S., Upadhya, K., Matson, P., Magee, S., Adger Jr, H., & Trent, M. (2021). Higher Marijuana use among Young Adults Persists Even during Pregnancy. Journal of Gynaecology and Obstetric Advancements, 1(1), 23.
30. Haffajee, R. L., Faherty, L. J., & Zivin, K. (2022). Pregnant women with substance use disorders: The harm associated with punitive approaches. Obstetric Anesthesia Digest, 42(1), 10.
31. Healthy People. (2020). [Internet]. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved March 16, 2018, from https://www.healthypeople.gov/456 Contemporary Drug Problems 45(4)
32. Jessup, M.A., Humphreys, J.C., Brindis, C.D., and Lee, K. A. Extrinsic barriers to substance abuse treatment among pregnant drug dependent women. Journal of Drug Issues 33(2):285-304, 2003.
33. Jones, H. E., Kaltenbach, K., Heil, S. H., Stine, S. M., Coyle, M. G., Arria, A. M., . . . Fischer, G. (2010). Neonatal abstinence syndrome after methadone or buprenorphine exposure. The New England Journal of Medicine, 363, 2320–2331.
34. Jos, P. H., Perlmutter, M., & Marshall, M. F. (2003). Substance abuse during pregnancy: Clinical and public health approaches. The Journal of Law, Medicine & Ethics, 31, 340–350.
35. Knight, K. R. (2020). Structural factors that affect life contexts of pregnant people with opioid use disorders: the role of structural racism and the need for structural competency. Women's Reproductive Health, 7(3), 164-171.
36. Knight, K. R. (2017). Women on the edge: Opioids, benzodiazepines, and the social anxieties surrounding women’s reproduction in the US “opioid epidemic.” Contemporary Drug Problems, 44, 301–320.
37. Ko, J.Y., Coy, K.C., Haight, S.C., Haegerich, T.M., Williams, L., Cox, S., Njai, R., and Grant, A.M. (2020). Characteristics of marijuana use during pregnancy—eight states, pregnancy risk assessment monitoring system, 2017. Morbidity and Mortality Weekly Report 69(32): 1058.
38. Ko, J. Y., Tong, V. T., Haight, S. C., Terplan, M., Snead, C., & Schulkin, J. (2020). Obstetrician–gynecologists’ practice patterns related to opioid use during pregnancy and postpartum—United States, 2017. Journal of Perinatology, 40(3), 412-421.
39. Kravitz, E., Suh, M., Russell, M., Ojeda, A., Levison, J., & McKinney, J. (2021). Screening for substance use disorders during pregnancy: a decision at the intersection of racial and reproductive justice. American Journal of Perinatology.
40. Krening, C., & Hanson, K. (2018). Marijuana—Perinatal and legal issues with use during pregnancy. The Journal of Perinatal & Neonatal Nursing, 32, 43–52. doi:10.1097/JPN.0000000000000303
41. Kunins, H. V., Bellin, E., Chazotte, C., Du, E., & Arnsten, J. H. (2007). The effect of race on provider decisions to test for illicit drug use in the peripartum setting. Journal of Women’s Health, 16, 245–255.
42. Lee, E., Pluym, I.D., Wong, D., Kwan, L., Varma, V., and Rao, R. (2020). The impact of state legalization on rates of marijuana use in pregnancy in a universal drug screening population. The Journal of Maternal-Fetal & Neonatal Medicine: 1-8.
43. Lester, B.M., Andreozzi, L., and Appiah, L. Substance Use During Pregnancy: Time for Policy to Catch Up with Research. Harm Reduction Journal 1:5, 2004.
44. MacDuffie, K.E., Kleinhans, N.M., Stout, K., and Wilfond, B.S. (2020). Protection versus progress: The challenge of research on cannabis use during pregnancy. Pediatrics 146, no. Supplement 1: S93-S98.
45. Madden, R. G. (1996). Civil commitment for substance abuse by pregnant women? A view from the front lines. Politics and the Life Sciences, 15, 56–59.
46. Madden, L. M., Oliva, J., Eller, A., DiDomizio, E., Roosa, M., Blanchard, L., ... & Johnson, K. (2022). Pregnant Women and Opioid Use Disorder: Examining the Legal Landscape for Controlling Women’s Reproductive Health. American Journal of Law & Medicine, 48(2-3), 209-222.
47. Mathieu, D. (1995). Mandating treatment for pregnant substance abusers: A compromise. Politics and the Life Sciences, 14, 199–208.
48. McCOURT, A. D., White, S. A., Bandara, S., Schall, T., Goodman, D. J., Patel, E., & McGINTY, E. E. (2022). Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy. The Milbank Quarterly.
49. Meinhofer, A., Witman, A., Maclean, J. C., & Bao, Y. (2022). Prenatal substance use policies and newborn health. Health Economics, 31(7), 1452-1467.
50. Merrick, J. C. (1993). Maternal substance abuse during pregnancy: Policy implications in the United States. Journal of Legal Medicine, 14, 57–71.
51. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press.
52. Ndanga, M., Sulley, S., & Saka, A. K. (2022). Trend analysis of substance use disorder during pregnancy. Cureus, 14(3).
53. Nguyen, R. H., Knapp, E. A., Li, X., Camargo, C. A., Conradt, E., Cowell, W., ... & program collaborators for Environmental Influences on Child Health Outcomes. (2023). Characteristics of Individuals in the United States Who Used Opioids During Pregnancy. Journal of Women's Health, 32(2), 161-170.
54. Omori, M. K. (2013). Moral panics and morality policy: The impact of media, political ideology, drug use, and manufacturing on methamphetamine legislation in the United States. Journal of Drug Issues, 43, 517–534.
55. Paltrow, L. M., Cohen, D. S., & Carey, C. A. (2000). Year 2000 overview: Governmental responses to pregnant women who use alcohol or other drugs. Women’s Law Project and the National Advocates for Pregnant Women, 1, 8.
56. Paltrow, L. M., & Flavin, J. (2013). Arrests of and forced interventions on pregnant women in the United States, 1973–2005: Implications for women’s legal status and public health. Journal of Health Politics, Policy and Law, 38, 299–343.
57. Qato, D. M., Zhang, C., Gandhi, A. B., Simoni-Wastila, L., & Coleman-Cowger, V. H. (2020). Co-use of alcohol, tobacco, and licit and illicit controlled substances among pregnant and non-pregnant women in the United States: Findings from 2006 to 2014 National Survey on Drug Use and Health (NSDUH) data. Drug and Alcohol Dependence, 206, 107729.
58. Richardson GA, Ryan C, Willford J, Day NL, Goldschmidt L. Prenatal alcohol and marijuana exposure: effects on neuropsychological outcomes at 10 years. Neurotoxicol Teratol. 2002;24(3):309-320.
59. Roberts, S.C., and Nuru-Jeter, A. Women’s Perspectives on Screening for Alcohol and Drug Use in Prenatal Care. Women’s Health Issues 20(3):193-200, 2010.
60. Roberts, S.C., and Pies, C. Complex Calculations: How Drug Use During Pregnancy Becomes a Barrier to Prenatal Care. Maternal and Child Health Journal 15(3): 333-41, 2011.
61. Roberts, S. C. M., & Nuru-Jeter, A. (2012). Universal screening for alcohol and drug use and racial disparities in child protective services reporting. Journal of Behavioral Health Services Research, 39, 1199–1216. doi:10. 1007/s11414-011-9247-x
62. Roberts, S. C., Raifman, S., & Biggs, M. A. (2022). Relationship between mandatory warning signs for cannabis use during pregnancy policies and birth outcomes in the Western United States. Preventive Medicine, 164, 107297.
63. Roberts, S.C.M., Thompson, T.A., and Taylor, K.J. (2021). Dismantling the legacy of failed policy approaches to pregnant people’s use of alcohol and drugs. International Review of Psychiatry 33(6): 502-513.
64. Rosenbaum, M. (1981). Women on heroin. New Brunswick, NJ: Rutgers University Press.
65. Ryan, Sheryl A., Seth D. Ammerman, and Mary E. O’Connor. "Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes." Pediatrics 142, no. 3 (2018).
66. Sanmartin, M. X., Ali, M. M., Lynch, S., & Aktas, A. (2020). Association between state-level criminal justice–focused prenatal substance use policies in the US and substance use–related foster care admissions and family reunification. JAMA Pediatrics, 174(8), 782-788.
67. Schneider, A., & Ingram, H. (1993). Social construction of target populations: Implications for politics and policy. American Political Science Review, 87, 334–347.
68. Schoneich, S., Plegue, M., Waidley, V., McCabe, K., Wu, J., Chandanabhumma, P. P., ... & Oshman, L. (2023). Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization. JAMA Network Open, 6(3), e232058-e232058.
69. Shi, Y., Zhu, B., & Liang, D. (2021). The associations between prenatal cannabis use disorder and neonatal outcomes. Addiction, 116(11), 3069-3079.
70. Simon, R., Giroux, J., & Chor, J. (2020). Effects of substance use disorder criminalization on American Indian pregnant individuals. AMA Journal of Ethics, 22(10), 862-867.
71. Skelton, K.R., Hecht, A.A., and Benjamin-Neelon, S.E. (2020). Recreational cannabis legalization in the US and maternal use during the preconception, prenatal, and postpartum periods. International Journal of Environmental Research and Public Health 17(3): 909.
72. Stone, R. (2015). Pregnant women and substance use: Fear, stigma, and barriers to care. Health & Justice, 3, 2. doi:10.1186/s40352-015-0015-5
73. Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 national survey on drug use and health: Summary of national findings (NSDUH Series H-48, HHS Publication No. (SMA) 14-4863). Retrieved from https://www.samhsa.gov
74. Substance Abuse and Mental Health Services Administration & Center for Behavioral Health Statistics and Quality. (2014, September 11). The N-SSATS report: Recovery services provided by substance abuse treatment facilities in the United States. Rockville, MD. Retrieved March 15, 2018, from https://www.samhsa.gov/data/sites/default/files/NSSATS-SR175-RecoverySv…
75. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Substance Use Among Women During Pregnancy and Following Childbirth. Rockville, MD: The National Survey on Drug Use and Health Report, 2009.
76. Suntai, Z. (2021). Substance use among women who are pregnant: Examining treatment completion by race and ethnicity. Journal of Substance Abuse Treatment, 131, 108437.
77. Tabatabaeepour, N., Morgan, J. R., Jalali, A., Kapadia, S. N., & Meinhofer, A. (2022). Impact of prenatal substance use policies on commercially insured pregnant females with opioid use disorder. Journal of Substance Abuse Treatment, 140, 108800.
78. Terplan, M. (2021). Substance use and use disorder in pregnancy and postpartum. International Review of Psychiatry, 33(6), 501-501.
79. Thomas, K. A., Struble, C. A., Stenersen, M. R., & Moore, K. (2022). The Impact of State-Level Prenatal Substance Use Policies on Rates of Maternal and Infant Mortality in the United States: A Legal Epidemiology Study. medRxiv, 2022-11.
80. Thomas, S., Treffers, R., Berglas, N. F., Drabble, L., & Roberts, S. C. M. (2018). Drug use during pregnancy policies in the United States from 1970 to 2016. Contemporary Drug Problems, 45(4), 441-459. doi: 10.1177/0091450918790790
81. Thompson, M., Vila, M., Wang, L., Thabane, L., & Shea, A. K. (2023). Prenatal cannabis use and its impact on offspring neuro-behavioural outcomes: A systematic review. Paediatrics & Child Health, 28(1), 8-16.
82. Vachhani, K., Simpson, A. N., Wijeysundera, D. N., Clarke, H., & Ladha, K. S. (2022). Cannabis use among pregnant women under different legalization frameworks in the United States. The American Journal of Drug and Alcohol Abuse, 48(6), 695-700.
83. Wendell, A. D. (2013). Overview and epidemiology of substance abuse in pregnancy. Clinical Obstetrics and Gynecology, 56(1), 91–6. https://doi.org/10.1097/GRF.0b013e31827feeb9 
84. Wetzel, L. M. (2018). Comparing policies on drug and alcohol use by pregnant women. Contemporary OB/GYN, 63(9), 26-27.
85. White, S. A., McCourt, A., Bandara, S., Goodman, D. J., Patel, E., & McGinty, E. E. (2023). Implementation of state laws giving pregnant people priority access to drug treatment programs in the context of coexisting punitive laws. Women's Health Issues, 33(2), 117-125.
86. Woodruff, K., Scott, K. A., & Roberts, S. C. (2021). Pregnant people’s experiences discussing their cannabis use with prenatal care providers in a state with legalized cannabis. Drug and Alcohol Dependence, 227, 108998.
87. Young, N.K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., and Amatetti, S. Substance-Exposed Infants: State Responses to the Problem. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2008.

Pregnancy and Drugs: Legal Significance for Child Abuse/Child Neglect

Pregnancy and Drugs: Limitations on Criminal Prosecution

Pregnancy and Drugs: Priority Treatment

Pregnancy and Drugs: Reporting Requirements

Pregnancy and Drugs: Warning Signs: Drugs During Pregnancy