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For decades, advocacy organizations have promoted an interdisciplinary framing—involving collaborative health, social service, and state interventions—as the best approach in cases of infants exposed to maternal prenatal substance use. However, across the United States, state legislatures have primarily authorized one profession to intervene in substance-exposed infants and their families: child welfare professionals. How did child welfare become the predominant authority to regulate this complex problem? This paper combines a historical content analysis of professional journals with a case study of California to argue that both conservative and liberal legislators began expanding child welfare authority during the 1990s due to two intertwined factors: child welfare’s risk management approach to managing marginalized mothers that fail to meet gendered expectations of maternal behavior, and the profession’s pre-existing resources to implement such population management practices. I explain these findings with a theory of gendered risk governance, in which professional and state actors manage marginalized mothers through risk management practices and discourses that reframe the reproduction of gendered, racial, and class inequalities as a neutral process of family regulation.