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In utero substance exposure continues to pose a public health and societal dilemma. Prenatal exposure to legal and illegal substances is a substantial and preventable risk factor for developmental alterations in infants. Intrauterine substance exposure affects more newborns than many other common major medical conditions, making the problem of the substance-exposed infant an inevitable concern for all pediatricians. Of the 4.3 million infants born annually in the United States, between 800,000 and 1 million are born to women who used drugs during pregnancy; approximately 1 in 9 infants is exposed to alcohol, 1 in 5 is exposed to nicotine, and 1 in 20 is exposed to illegal drugs. Opioid use during pregnancy is a growing concern due to the rise in abuse of prescription opioids (eg, hydrocodone, oxycodone) in women of childbearing age.

Currently, 5.4 million children live with a parent...

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