Academic journal article Child Welfare

Outcomes for Infants Exposed in Utero to Illicit Drugs

Academic journal article Child Welfare

Outcomes for Infants Exposed in Utero to Illicit Drugs

Article excerpt

The study reported here sought to determine whether substance-exposed infants who are maltreated have a higher risk of out-of-home placement than substanceexposed children who are not abused and rejected, as well as a higher risk of death than children in the general population. In a sample of 513 infants born at a Chicago medical center from 1985 through 1990, 480 (93.6%) had complete sociodemographic data available for analysis. Identifying data were used to search the Illinois death registry and a computerized central registry of child abuse reports. Both out-of-home placement and death were distinctly more likely if children had been exposed to drugs and maltreated. Such children should be closely followed.

The number of children needing out-of-home care has nearly doubled since 1985 [American Humane Association 1993]. This increase in the use of out-of-home care parallels the explosion of substance abuse in the United States. Although the exact number of pregnant women who are substance abusers is not known, the 1991 National Household Survey on Drug Abuse, conducted among women of childbearing age, reported that 27% of 18- to 25-year-olds and 14.7% of 26- to 34-year-olds had used an illicit drug in the preceding year [U.S. Department of Health and Human Services 1991]. Studies of different populations of pregnant women or their newborns indicate that 10% to 17% of these women took cocaine at some time during their pregnancy [Chasnoff 1989; Schutzman et al.1991; Cook et al. 1990; Chasnoff et al.1990].

In the early 1990s, projections for the United States were that an estimated 350,000 to 625,000 newborns would have been exposed yearly to drugs prenatally [Gomby & Shiono 1991; Chasnoff 1989; Hans 1989]. In Illinois, the number of substance-exposed infants who were reported to the Department of Children and Family Services rose from 181 in 1985 to 2,405 in 1990 [Illinois Department of Children and Family Services 1990]. It is, however, generally believed by social service agencies and medical personnel that the number of newborns exposed in utero to drugs may be decreasing.

The reported number of child fatalities attributable to maltreatment is rising. For 1992, the number of deaths that could be substantiated as caused by maltreatment was 1,123 [McCurdy & Daro 1993] compared with 920 in 1987. Moreover, this alarming number is probably vastly underestimated, as child homicide appears to be underreported by at least 20% [Jason 1984], and deaths of children are often incorrectly attributed to illness rather than maltreatment [Christoffel et al. 1985].

The present study examines the incidence of out-of-home care and death of substance-exposed infants. We hypothesize that among infants exposed in utero to drugs, those placed in family foster homes differed significantly from those not placed in family foster homes. The children placed will have been more frequently abused than those not so placed. Death rates among substanceexposed infants will be higher than death rates for infants in the general population.


Hospital Data (Chicago Lying-in Hospital)

Data for the study were obtained by reviewing the records of all infants born at the University of Chicago's Lying-In Hospital from January 1985 through December 1990 for evidence of prenatal exposure to drugs, as well as the records of their mothers. The child's name, date of birth, gender, and mother's name were then used to search the Illinois death registry and a central registry of child abuse reports.

Illinois law requires reporting of all infants exposed in utero to illicit drugs. Exposure of an infant to illicit substances is established by appropriate laboratory tests to confirm the presence of heroin, opiates, marijuana, phencyclidine (PCP), or cocaine in the urine of the infant. At the Chicago Lying-In Hospital, however, we assumed that prenatal exposure to drugs had occurred if the urine of the infant or mother tested positive for illicit drugs, or if the woman admitted to chronic use of illicit drugs during the pregnancy in question. …

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