The findings indicated that three maternal characteristics were associated with loss of infant custody after control for other drug use, cognitive factors, and demographic variables. These variables were few prenatal care visits, heavier cocaine use, and clinically elevated psychological distress. Women who did not maintain infant custody used significantly more cocaine during pregnancy than women who maintained custody, although the level and rates of use or substances including tobacco, marijuana, and alcohol were not different. Women who lost paternal custody were also more likely to have clinically elevated psychological distress symptoms than women who maintained paternal custody. A sub analysis also revealed an independent association of childhood internal emotional neglect with nonmaternal care status. Findings show that women known to have used cocaine during their pregnancy and who have had their child removed from their custody should be considered at risk for higher levels of cocaine use, psychological distress, and a history of emotional neglect. Additionally, they are more likely to have received suboptimal levels of prenatal care. Thorough assessment of these risks for both mother and infant, and referral for appropriate health, mental health, and substance abuse treatment should be priority. Data were collected from a sample of 218 cocaine-using mothers and their prenatally exposed infants from a large urban county teaching hospital maternity ward between September 1994 and June 1996. Tables, references