Drugs and Pregnancy: What Happens If Your Baby Tests Positive For Drugs or Alcohol?

Clinical Reviewer
How drug or alcohol use while pregnant is handled depends on state laws, and, more importantly, on the actions of the mother. A woman that stays compliant with an inpatient or outpatient addiction treatment program will have a dramatically better outcome than a woman that tries to quit on her own or feels too helpless to seek treatment.

Do doctors test for drugs or alcohol while pregnant?

The American College of Obstetricians and Gynecologists (ACOG) recommends only verbal screening for drugs and alcohol during all prenatal visits.  

Physicians are supposed to have informed consent before drug testing a pregnant patient. But, drug testing without consent does happen.  In many states, including Illinois, patients may refuse a drug screen even if drug or alcohol use is suspected.

NOTE: Newborn drug testing is required and can measure repeated drug use during pregnancy, even if substance use was stopped 4-5 months before delivery. (Read more below).

Do doctors report drug or alcohol use of pregnant patients?

In most states and situations, OBGYN physicians and hospital workers do report failed drug screens and even suspected drug use of pregnant women to state agencies. Alcohol use is less likely to be reported.

While reporting is not always mandated, it can give pregnant women the resources to stop the substance use while still pregnant. Results of newborn drug and alcohol screens are mandated to be reported anyway, but too late for prevention.

As an addiction treatment provider, we do not report opioid drug screens while pregnant. But, we can provide positive drug screen results to an OBGYN if the patient signs a release of information. Showing compliance in a treatment program is the best way to limit any child welfare involvement.

Examples: Illinois & Texas

The Department of Human Services notifies the local Infant Mortality Reduction Network and child welfare to:

  1. Refer the parents to a treatment program for an assessment to determine whether they have an alcohol or other drug abuse problem and need treatment.
  2. Complete a client service plan that describes monitoring and services for the family; the treatment plan for the parents; and the medical plan for the infant.

Following the client service plan, especially compliance with the addiction treatment program dramatically reduces the likelihood of further actions like removing the newborn.

Texas has a program called Pregnant and Parenting Intervention (PPI) that can help women get treatment and resources. Being successful in a treatment program is the best way to limit any consequences. While it can depend on the county, Texas is generally much harsher with these laws than other states.

Do hospitals drug test newborns?

All newborns are given a toxicology screen as part of a routine newborn physical assessment, which shows exposure to drugs, alcohol and MAT medications. Hospitals are required to report any exposures to Child Protective Services (CPS) under the Child Abuse Prevention and Treatment Act (CAPTA).  

Each hospital sets its own protocols around how and when newborn testing occurs. Testing the meconium (the baby’s first feces) is common and detects drug and alcohol use in the last 4 to 5 months of pregnancy. Meconium testing can also detect the severity of the substance use.

Newborn Drug Screen Options

Newbord Drug Testing Methods Compared - Urine, Unbillical Cord, Meconium

Do hospitals test newborns for Suboxone?

Yes, MAT medications like Suboxone and methadone are included in the routine newborn screen.  If a mother has not self-reported MAT use to their OBGYN, this could create an unwanted investigation and delay in being able to take the newborn home since the reporting physician would not be able to validate the prescription. Illegal use of MAT medications usually trigger an investigation. 

Do hospitals test newborns for alcohol?

Yes, alcohol is part of the routine newborn screening. But, only the alcohol use in the 2-3 days prior to delivery are likely to show. A newborn testing positive for alcohol or showing signs of Fetal Alcohol Spectrum Disorder are required to be reported to CPS.

Can women be prosecuted for using drugs or alcohol during pregnancy?

Drug use during pregnancy usually triggers an investigation that could result in loss of custody rights. Alcohol or marijuana use aren’t always included in these laws, which vary by state.

Even in conservative states, there is usually no criminal prosecution or jail time for alcohol or drug use while pregnant. Progressive states do more to help pregnant women find treatment since studies show punishment is ineffective in preventing substance use during pregnancy.

Each patient’s monitoring and intervention by CPS is on a case-by-case basis, depending on the actions and compliance of the mother. Showing success in an addiction treatment program always helps the outcome of a case.

Examples: Illinois & Texas

Alcohol and marijuana are not included in Illinois legislation.

A newborn testing positive for drugs other than marijuana triggers a Department of Children and Family Services (DCFS) investigation.

After medical records are validated, a DCFS investigator will:

  1. Conduct a thorough risk assessment including evaluating the environment where the infant will live and evaluating the caregiver and other adults or children living in or frequenting the home.
  2. Take temporary protective custody if there are risk factors that place the child in imminent danger.
  3. Open a child welfare for a comprehensive assessment and ongoing plan.

Even if a case gets closed, these investigations can take three months and the file can remain open for five years.

Illinois enacted the Reproductive Health Act (RHA) in 2019 to protect women from being criminally prosecuted for drug or alcohol use while pregnant – meaning no incarceration or other criminal consequences.

When a report is received in Texas that a newborn was exposed to alcohol or drugs, a caseworker must complete a risk assessment within 30 days. The Department of Family and Protective Services (DFPS) may schedule a family conference to develop a safety plan for the newborn.

Newborn exposure to a controlled substance is counted as neglectful supervision in Texas. Controlled substances in Texas include marijuana, as well as methadone or Suboxone without prescription, but not alcohol. Though, no Texas news outlet has reported a woman prosecuted solely for drug abuse during pregnancy since 2017.

The court may order the termination of the parent-child relationship if the parent used drugs in a manner that endangered the health or safety of the child, and:

  • Failed to complete a court-ordered substance abuse treatment program
  • After completion of a court-ordered substance abuse treatment program, continued to abuse a controlled substance
  • Been the cause of the child being born addicted to alcohol or a controlled substance, other than by legal prescription
  • That termination is in the best interests of the child

The laws are harsher in Texas than other states, but showing compliance with an addiction treatment program always improves the outcome of a case.

Can you force a pregnant woman to go to a treatment program?

In most states and situations, there is no specific law that allows a loved one to commit a pregnant woman to a hospital, rehab or outpatient addiction treatment program. 

Though other involuntary commitment laws for substance abuse can apply like the Marchman Act in Florida, Casey’s law in Kentucky/Ohio and Health & Safety Code § 463.062 in Texas. (A bill for involuntary commitment for substance abuse was proposed, but not passed in Illinois in 2017).

Be Proactive in Getting Help

It’s normal to feel overwhelmed, guilty, helpless or worried. But, don’t let those negative emotions stop you from getting help. 

You already know that getting treatment will dramatically:

Get Help Now

Symetria doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the field.

Branigin, A. (2022, July 2). A false positive on a drug test upended these mothers’ lives. Retrieved July 27, 2022, from Washington Post website: https://www.washingtonpost.com/lifestyle/2022/07/02/false-positive-drug-test-mothers/

Pregnant & Parenting Intervention | Texas Health and Human Services. (2016). Retrieved July 27, 2022, from Texas.gov website: https://www.hhs.texas.gov/services/mental-health-substance-use/adult-substance-use/pregnant-parenting-intervention

State Statutes Search – Child Welfare Information Gateway. (2022). Retrieved July 27, 2022, from Childwelfare.gov

All content is for informational purposes only. No material on this site, whether from our doctors or the community, is a substitute for seeking personalized professional medical advice, diagnosis or treatment. Never disregard advice from a qualified healthcare professional or delay seeking advice because of something you read on this website.

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  • I’m pregnant and trying to quit smoking weed before this baby comes into the world with a clean system …do u have any suggestions for me as I am living in a hotel right now and need permanent housing.

    1. The most aggressive treatment option would be to admit into a residential treatment facility for up to 30 days. Most facilities will have further resources, such as a social worker who can help you find affordable permanent housing that is best for you after you leave the facility. Another option would be to visit your local health department, they can connect you with counseling to help you stop cannabis use, and they often have social workers there as well. Another great option is looking into a sober living home, which will be great for helping you to stop your cannabis use, and also address your living situation. I’m not familiar with locations where you live (Michigan), but you should be able to find treatment facilities, counselors and social workers near you that accept your insurance via your health insurance’s website.

  • If I used meth up until 23 wks pregnant because I didn’t know I was pregnant will it show up in the baby?

    1. It is possible it will still show up if they test the meconium, since meconium testing can detect any drugs used by the mother during the last 5 months of pregnancy. However, it would not show up on urine or umbilical cord testing.

  • So will the drug test at the hospital only detect the amount of alcohol use in the past 2 to 3 days before delivery or 4 to 5 months before delivery?

    1. It depends on what tests your hospital chooses to perform. If they test the meconium (the baby’s first feces), alcohol can be detected if it was used up to 5 months before delivery. Blood and urine testing would only detect recent alcohol use within the past 2-3 days. If meconium is tested for alcohol, it can reveal the severity of the alcohol use (i.e. heavy daily use vs. occasional use), so don’t be afraid if you just had a couple of alcoholic drinks per month. Even if there is alcohol detected on either test, the most important factor is the health of the baby.

  • I have a friend who is 26 weeks pregnant today. She Tried meth for the first time today. Will it still show up in the baby system by the time she gets ready to have it on Feb 14, which is her due date? She only did like 6 thin lines at the most.

    1. One-time methamphetamine use several months prior to delivery is unlikely to show on a newborn drug screen.

  • What’s the highest level for crack cocaine to be in the babies umbilical cord bloodstream fingernails urine for (DCFS) to remove the child from their home

    1. Any amount of illicit drugs found in a newborn drug screen will likely trigger an investigation. What determines if the child should be removed is not the level of drugs found during testing, but the safety and welfare of the child as determined by the investigation (which includes any continued drug use of those in the home).

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