State Child Abuse and Mandated Reporting Policies for Prenatal Substance Use and Congenital Syphilis Case Rates: United States, 2018–2022.

This article examines the association between state policies on prenatal substance use—specifically, child abuse policies that define prenatal substance use as child abuse and mandated reporting policies requiring health care professionals to report prenatal substance use to child protective services (CPS)—and rates of congenital syphilis in the United States from 2018 to 2022. Using national surveillance data and adjusted regression analyses, the study found that states with both child abuse and mandated reporting policies had significantly higher congenital syphilis case rates compared to states with neither policy, while states with only one of these policies showed similar rates to those with neither. The findings suggest that the combined presence of these policies may create barriers to prenatal care and timely syphilis testing and treatment, potentially contributing to increased congenital syphilis cases. The study also highlights disparities in policy exposure among racial and ethnic groups and underscores missed prevention opportunities related to delayed testing and inadequate treatment across all policy contexts.