About 5% of women (or 1 in 20) use substances while they are pregnant. These substances may range from nicotine and alcohol to prescription or illicit drugs. Substance use during pregnancy can result in a range of side effects for both the mother and baby, including congenital disabilities, miscarriage, stillbirth, and infertility.

Many women who find themselves pregnant amid substance use often do not seek treatment due to stigma and other potential consequences, but asking for help if you are pregnant and struggling with substance abuse or addiction can be the beginning of a safe pregnancy and healthy life for you and your baby.

How Substance Use Can Affect Pregnancy

During pregnancy, many substances a woman takes can easily affect the fetus significantly—nearly everything a mother consumes or comes into contact with passes through the placenta and blood-brain barrier. Smoking cigarettes, cannabis, or e-cigarettes, drinking alcohol, and using prescription and illegal drugs can double or triple the likelihood of stillbirth.

Regular use of substances beyond the first trimester of pregnancy also multiplies a child’s risk of sudden infant death syndrome (SIDS) by twelvefold. Other effects of substance use during pregnancy may include preterm birth, low birth weight, heart defects, smaller head circumference, and other congenital disabilities.

Neonatal Abstinence Syndrome (NAS)

If a pregnant woman uses substances regularly enough before giving birth, the child may experience neonatal abstinence syndrome (NAS). During NAS, the baby goes through withdrawal upon birth. However, withdrawal symptoms in newborns can present immediately or up to 14 days after birth. Symptoms of NAS can vary widely, and their severity may depend on how the mother’s body metabolizes substances, the duration and frequency of the mother’s substance use, and whether the pregnancy was carried to term.

Symptoms of neonatal abstinence–or substance withdrawal in an infant–may include the following:

  • Increased muscle tone
  • Hyperactive reflexes, trembling, or abnormal sucking reflex
  • Inconsistent feeding patterns or slow weight gain
  • Rapid breathing
  • Seizures
  • Fever or sweating
  • Excessive crying
  • Irritability
  • Blotchy complexion


Illegal Drug Use During Pregnancy

During pregnancy, the mother’s cardiovascular system is working overtime, and research shows that using stimulants like cocaine or methamphetamine can lead to high blood pressure during pregnancy or preeclampsia. Preeclampsia alone can cause a difficult delivery, but cocaine and methamphetamine use during pregnancy, coupled with high blood pressure, increases the risk of placental abruption. Placental abruption occurs when the placenta detaches from the mother’s uterus, which can lead to premature birth or sudden miscarriage.

Pregnant women who use cocaine are more likely to experience seizures, while children exposed to methamphetamine in utero are at a higher risk of developing depression, anxiety, or cognitive deficiencies. Heroin and opioid use during pregnancy are specifically linked to neonatal abstinence syndrome.

Prescription, OTC, and Legal Substance Use During Pregnancy

When it comes to legal substances, it can be confusing for pregnant women trying to figure out what is safe and unsafe to take. The majority of pregnant women take OTC or prescription medicines of some kind. There’s currently little research about the safety of medications and prescription drug use in pregnant women because pregnant women often are not subjects in studies conducted to determine the safety of medications before they enter production.

Unfortunately, researchers only know the effects of a few medications on pregnancy, partly because physicians cannot prescribe pregnant women medications without knowing of potential harmful side effects. However, some data shows links between prescription opioids like oxycodone and a higher risk of NAS in infants. The likelihood may be even higher if the mother also uses tobacco or specific antidepressants during pregnancy.

Treatment and Detox Options

For women who are pregnant and take prescription or OTC medications, it’s important to tell your doctor so they can help determine the safety of those medications. Quitting a medication or substance suddenly during pregnancy can cause severe health issues in both the mother and baby and in some cases, it can be deadly.


Seeking professional help or talking to your healthcare provider can help you safely quit taking a substance, whether it is OTC, prescription, or illicit. Many substance use treatment centers offer medication-assisted therapies that use drugs like methadone and buprenorphine to support safe detox and recovery processes.  

Substances ranging from nicotine and alcohol to prescription opioids and illegal drugs can lead to a variety of issues when used during pregnancy. Both the stigma associated with substance use and a fear of judgment often deter women from seeking help. Still, intervention is crucial in mediating the risk of using prescription, over-the-counter, or illicit substances during pregnancy.