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Substance Exposure In Utero

CPQCC is currently working on two undertakings related to substance exposure in utero - a joint project with CMQCC and Health Management Associates that aims to improve outcomes for mothers and newborns affected by substance exposure, and an internal workgroup that is looking at how to improve data collection and treatment for at-risk infants within and beyond CPQCC member hospitals. 

Why we care about this topic

Neonates who have been exposed to substances in utero, both prescribed and non-prescribed, are at risk for health problems at birth. With opioid use during pregnancy on the rise, infants are at an increased risk of in utero exposure and of developing withdrawal symptoms at birth, a condition known as neonatal abstinence syndrome (NAS). Between 1999 and 2013, NAS incidence increased 300% from 1.5/1,000 hospital births to 6.0/1,000 hospital births1. By 2012, one infant was born every 25 minutes, on average, experiencing signs of withdrawal2. Infants who are also exposed to other illicit drugs, alcohol, nicotine, and selective serotonin reuptake inhibitors (SSRIs) are at increased risk of developing NAS3.

Our approach

The Mother & Baby Substance Exposure Initiative 

The Mother & Baby Substance Exposure Initiative, part of California's Medication Assisted Treatment Expansion Project, is being implemented by CPQCC and  CMQCC in partnership with Health Management Associates (HMA).  This initiative is being piloted in select counties across the state and will center around a hospital-based quality improvement collaborative. 

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The Maternal Substance Exposure Workgroup 

The Maternal Substance Exposure Workgroup is made up of committed individuals from CPQCC member hospitals who are interested in improving data collection and treatment for infants who have been exposed to substances in utero.  The workgroup is developing tools that will be available to all hospitals across the state including those which are not members of CPQCC, starting with a data collection pilot project

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  • How do I know if my hospital is part of a selected county for the Mother & Baby Substance Exposure Initiative?

Hospitals in the following counties will be recruited to participate in the initiative: Mendocino, Lake, Shasta, Humboldt, Sacramento, Stanislaus, San Joaquin, Ventura, Orange, and San Diego. If you have any questions about hospital recruitment, please email

  • If my hospital is in one of the selected counties for the Mother & Baby Substance Exposure Initiative, can we also participate in the Maternal Substance Exposure Data Collection Pilot?

If your hospital is recruited to participate in the Mother & Baby Substance Exposure Initiative, you are strongly encouraged to participate in the Maternal Substance Exposure Data Collection Pilot as well. Please email for more details. 

  • If my hospital is not a member of CPQCC, can we still participate in the Maternal Substance Exposure Data Collection Pilot?

Yes! We invite all California hospitals interested in collecting data on substance exposure in-utero to participate in the data collection pilot. Please visit this page for more details. 

For more information


  1. Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. MMWR Morb Mortal Wkly Rep 2016;65:799–802. DOI:
  2. Patrick SW, Schiff DM, AAP Committee on Substance Use and Prevention. A Public Health Response to Opioid Use in Pregnancy. Pediatrics. 2017;139(3):e20164070
  3. Desai RJ, Huybrechts KF, Hernandez-Diaz S, Mogun H, Patorno E, Kaltenbach K, Kerzner LS, Bateman BT. Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: a population based cohort study. BMJ. 2015; 350: h2102. DOI: