{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:04:28Z","timestamp":1790186668906,"version":"4.1.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100030692","name":"Intramural Research Program, National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["F31DA057756"],"award-info":[{"award-number":["F31DA057756"]}],"id":[{"id":"10.13039\/100030692","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH138475"],"award-info":[{"award-number":["R01MH138475"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000130","name":"National Center for Chronic Disease Prevention and Health Promotion","doi-asserted-by":"publisher","award":["K01CE003548"],"award-info":[{"award-number":["K01CE003548"]}],"id":[{"id":"10.13039\/100000130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Discretionary child protection system (CPS) reporting policies allow some substance-exposed infants to be discharged from the hospital without a maltreatment report, but it is unknown whether risk for later system involvement varies according to exposure status. We conducted a retrospective cohort analysis of CPS involvement in the first 5 years of life as predicted by prenatal substance exposure among California births in 2018. At 5 years, less than 14% of exposed children experienced CPS reports of maltreatment harm or substantiated CPS reports. Exposed children were more likely to be reported for maltreatment harm at 5 years (adjusted Risk Difference (aRD)=0.03, 95%CI: 0.02, 0.04), including a subgroup with only cannabis exposure (aRD\u2009=\u20090.03, 95%CI: 0.02, 0.04) compared with unexposed infants. Prenatally exposed children were more likely to experience a substantiated report within 5 years compared with those without exposure (aRD\u2009=\u20090.03, 95%CI: 0.02, 0.03). Findings suggest that families affected by prenatal substance exposure who do not have apparent safety concerns at birth may benefit from support to prevent future instances of system intervention or child maltreatment.<\/jats:p>","DOI":"10.1371\/journal.pone.0357388","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:21:11Z","timestamp":1790184071000},"page":"e0357388","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prenatal substance exposure and 5-year child protection outcomes among infants not reported at birth"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0314-6959","authenticated-orcid":true,"given":"Julia","family":"Reddy","sequence":"first","affiliation":[{"name":"University of North Carolina Chapel Hill School of Social Work","place":["Chapel Hill, North Carolina, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davida M.","family":"Schiff","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, Massachusetts, United States of America"],"department":["MassGeneral Hospital for Children"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Austin","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendree E.","family":"Jones","sequence":"additional","affiliation":[{"name":"University of North Carolina Chapel Hill","place":["Chapel Hill, North Carolina, United States of America"],"department":["Department of Obstetrics & Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Faherty","sequence":"additional","affiliation":[{"name":"RAND","place":["Boston, Massachusetts, United States of America"]},{"name":"MaineHealth","place":["Portland, Maine, United States of America"]},{"name":"Tufts University","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6759-1701","authenticated-orcid":true,"given":"Rebecca","family":"Rebbe","sequence":"additional","affiliation":[{"name":"University of North Carolina Chapel Hill School of Social Work","place":["Chapel Hill, North Carolina, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anissa","family":"Vines","sequence":"additional","affiliation":[{"name":"University of North Carolina Chapel Hill Gillings School of Global Public Health","place":["Chapel Hill, North Carolina, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Putnam-Hornstein","sequence":"additional","affiliation":[{"name":"University of North Carolina Chapel Hill School of Social Work","place":["Chapel Hill, North Carolina, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"2","key":"pone.0357388.ref001","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1177\/1077559521990116","article-title":"Prenatal substance exposure and child maltreatment: a systematic review","volume":"27","author":"AE Austin","year":"2022","journal-title":"Child Maltreat"},{"issue":"3","key":"pone.0357388.ref002","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-1273","article-title":"Prenatal substance exposure and reporting of child maltreatment by race and ethnicity","volume":"138","author":"E Putnam-Hornstein","year":"2016","journal-title":"Pediatrics"},{"key":"pone.0357388.ref003","article-title":"What does child protective services investigate as neglect? 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