Background <p>The intersection of substance use disorder (SUD) among pregnant and parenting women (PPW) and the child welfare system is a topic that spans multiple systems, including child welfare, public health, and SUD treatment. Some components of this multi-systemic issue have been addressed through various research initiatives, but they are siloed in their approaches. This article provides an overarching summary of existing research by reviewing the literature on PPW with SUD and how current policies impact their experiences within the child welfare system. This scoping review identifies key patterns, challenges, and outcomes faced by this vulnerable population, highlighting the profound implications for both mothers and their children.</p> Methods <p>Searching in five databases yielded 93 studies for inclusion, broken down into general categories of systems involvement, removal, treatment and relapse risk, and marijuana/alcohol in pregnancy.</p> Results <p>Findings indicate that substance use significantly exacerbates legal, social, and moral challenges for women, leading to high rates of child removal and placement in out-of-home care. In addition, the complexities of managing SUD during pregnancy while navigating multiple systems with inherent structural stigma are explored.</p> Conclusion <p>This review underscores the necessity for targeted interventions and support systems to mitigate adverse outcomes for both mothers and children. Through identification of both systemic intersections and personal experiences, this review provides essential insights and recommendations for future practice, policy, and research to better support PPW with SUD within the child welfare systems framework.</p>