Understanding Infant Mortality In the Context of Perinatal Substance Use: A Scoping Review

Background: Infant mortality is a persistent public health crisis in the United States and is frequently associated with perinatal substance use. Underlying this crisis are not only individual-level risk factors, but also broader structural and systemic forces that shape access to care and support during the perinatal period.

Purpose: This scoping review synthesizes current knowledge on maternal substance use and infant mortality, examining how risk is conceptualized and measured across the literature. It also identifies key research and policy gaps.

Methods: Following PRISMA-ScR guidelines, four databases (MEDLINE, PsycINFO, SocINDEX, and CINAHL) were searched for peer-reviewed U.S.-based empirical studies examining perinatal substance use and infant mortality. Eligible studies were synthesized using a narrative approach.

Results: Twelve articles met inclusion criteria for this scoping review. Across studies, perinatal substance use was consistently associated with increased risk of infant mortality. Results highlighted that most studies relied on single-substance analytic approaches despite measuring multiple substances. Racial and socioeconomic disparities were evident throughout the literature.

Conclusions: The existing literature provides consistent evidence of risk but offers limited insight into how that risk is shaped by lived experience. Key gaps in research include limited research on the complexities of polysubstance use, the underrepresentation of rural and Native American populations, and a lack of qualitative research. Addressing these gaps is critical for developing more responsive, non-punitive, and contextually grounded approaches to perinatal substance use and infant mortality.