(155) The association between participation in a comprehensive addiction medicine prenatal care program and child custody

Objective: Patients with substance use disorder (SUD) are more likely to lose custodial rights than those who do not have SUD. We evaluated the effect of a comprehensive addiction in pregnancy program (CAPP) on parental custody.

Study Design: Retrospective cohort of pregnant patients with SUD who delivered a liveborn neonate at ≥22 weeks gestational age (GA) at a referral center in the southeast US (4/9/2018-8/5/2022). Patients with SUD were divided into 2 groups: those who attended CAPP and those who did not (non-CAPP). CAPP combines perinatal care with social services, case management, peer support, ±pharmacotherapy. CAPP participation requires entry to care < 32 weeks GA and score ≥4 on the National Institute on Drug Abuse – Modified Assist Tool. The primary outcome was proportion of neonates discharged with the birthing parent. Secondary outcomes included neonatal opioid withdrawal syndrome (NOWS), neonatal urine drug screen (UDS) at delivery, and neonatal length of stay (LOS). Outcomes were compared between groups.

Results: Overall, 431 patients were included: 153 CAPP, 278 non-CAPP. CAPP patients initiated prenatal care earlier than non-CAPP (p< .001) and delivered at a greater mean GA (38.9 vs 37.9 weeks, p=.047, Table 1). CAPP neonates were more likely to be discharged home in parental custody (77% vs 58%, OR 2.49 [1.55-4.01], Table 2). There was no difference in diagnosis of NOWS (OR 1.20 [0.78-1.86]) or neonatal LOS (OR -0.61 [-5.19-3.97]). Neonatal UDS was less likely to be positive (OR 0.45 [0.29-0.72]) among CAPP neonates compared to non-CAPP neonates.

Conclusion: Participation in CAPP was associated with parental custody, though nearly one-quarter of participating individuals were not granted custody. Further research is needed to understand how to safely support custodial rights for all birthing persons with SUD interested in parenting.