title: Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems.
abstract: OBJECTIVE
  To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland.
  
  
  METHODS
  A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register.
  
  
  RESULTS
  Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital.
  
  
  CONCLUSIONS
  There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.
authors.affiliation: Department of Pediatrics, Helsinki University Central Hospital for Children and Adolescents, POB 281, FIN-00029 HUCH, Helsinki, Finland. taisto.sarkola@hus.fi
authors.forename: Taisto
authors.initials: T
authors.lastname: Sarkola
authors.forename: Hanna
authors.initials: H
authors.lastname: Kahila
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Erja
authors.initials: E
authors.lastname: Halmesmäki
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000517:prevention & control; D002655:Child Custody / Q000706:statistics & numerical data*; D016241:Child of Impaired Parents / Q000523:psychology* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005581:Foster Home Care / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008427:Maternal Health Services; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology