Disparities in maternal-infant drug testing, social work assessment and custody at five hospitals


To evaluate for disparities in peripartum toxicology testing among maternal-infant dyads across a hospital network and subsequent child protective services (CPS) involvement.


Retrospective chart review of 59,425 deliveries at five hospitals in Massachusetts between 2016-2020. We evaluated associations between maternal characteristics, toxicology testing and child welfare involvement with disproportionality risk ratios and hierarchical logistical regression.


Toxicology testing was performed on 1959 (3.3%) dyads. Younger individuals and individuals of color were more likely to be tested for cannabis use or maternal medical complications compared to white non-Hispanic individuals. Among those without a substance use disorder, age <25 (aOR 2.81, 95% CI 2.43-3.26), race/ethnicity (non-Hispanic Black (aOR 1.80, 95% CI 1.52-2.13), Hispanic (aOR 1.23, 95% CI 1.05-1.45), mixed race/other (aOR 1.40, 95% CI 1.04, 1.87), unavailable race (aOR 1.92, 95% CI 1.32-2.79), and public insurance (Medicaid (aOR 2.61, 95% CI 2.27-3.00), Medicare (aOR 13.76, 95% CI 9.99-18.91)) had increased odds of toxicology testing compared to older, white non-Hispanic, and privately insured individuals. The disproportionality ratios in testing were greater than 1.0 for individuals under 25 years old (3.8), Hispanic individuals (1.6), non-Hispanic Black individuals (1.8), individuals of other race (1.2), unavailable race (1.8), and individuals with public insurance (Medicaid 2.6; Medicare 10.6). Among dyads tested, race/ethnicity was not associated with CPS involvement.


Peripartum toxicology testing is disproportionately performed on non-white, younger, and poorer individuals and their infants, with cannabis use and medical complications prompting testing more often for patients of color than for white non-Hispanic individuals.

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