This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the concepts related to whether or not drug use during pregnancy can be considered child abuse
2. Describe some of the medical and public policy issues that may arise when considering prosecution in the setting of an opioid epidemic
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Sema4, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Postgraduate Institute for Medicine designates this continuing education activity for 0.2 contact hour(s) (0.2 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number – )Type of Activity: Knowledge
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.Read Disclaimer & Fine Print
The Pennsylvania Supreme Court, in the case of In the Interest of L.J.B., ruled that mothers who used illegal drugs during pregnancy cannot be charged with child abuse offenses. The case arose from a pregnant mother who took unprescribed sublingual buprenorphine, a treatment for her opioid addiction, following relapse from a methadone maintenance program. She tested positive for marijuana and buprenorphine after delivery. The newborn suffered from neonatal abstinence syndrome (NAS) starting by the third day, exhibiting tremors, excessive suck, increased muscle tone and loose stools. The mother was discharged from the hospital, but the newborn remained. The hospital, therefore, made a room available for the mother to stay. However, she did not stay and contact with her child was inconsistent. The local child welfare agency was granted emergency protective custody of the newborn in juvenile court. It also filed a petition in court alleging the child “without proper parental care or control … as required by law” and was a victim of child abuse by a perpetrator (parent of a child) who caus[ed] bodily injury to a child through any recent act or failure to act” under Pennsylvania law. The infant was hospitalized for 19 days during which she “suffer[ed] from withdrawal due to substances Mother ingested while Mother was pregnant with her.”
The mother argued against the charge, asserting that Pennsylvania law for child abuse does not cover a fetus or unborn child. The juvenile court agreed with the mother but the child welfare agency appealed to Superior Court. Superior Court reversed the decision and found that “Mother’s illegal drug use while pregnant may constitute child abuse if the drug use caused bodily injury to Child.” Although agreeing with the mother that a fetus or unborn child is not included in the definition of “child” in the CPSL, it found that “Mother’s drug use is a ‘recent act or failure to act’,” and that her conduct caused or was reasonably likely to cause injury to Child who, now born, constituted a “child.” It therefore held “that a mother’s use of illegal drugs while pregnant may constitute child abuse under if established that, by using the illegal drugs, the mother intentionally, knowingly, or recklessly caused, or created a reasonable likelihood of, bodily injury to a child after birth.” One Superior Court judge, although agreeing with the decision, raised the question whether pregnant woman with addiction problems would avoid prenatal care for fear of being charged with child abuse. The decision could also extend to other decisions that pregnant women make such as drinking coffee or eating sushi. An appeal to the state Supreme Court followed.
The state Supreme Court ruled that since the definition of “child” in the statute did not include a fetus, a pregnant woman cannot fit the definition of a “perpetrator” meaning parent of a child under the law because she is not the “parent of a child”. The fact that the mother became a parent upon delivery did not alter this fact. The ruling was considered a “great victory for public health, women’s rights and children’s rights.” In keeping with the comment of the superior court judge, treatment for addiction during pregnancy likely makes for good medical policy, rather than prosecution. This may be especially relevant in the context of the current opioid epidemic, which is also a statewide emergency in Pennsylvania.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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