Substance Use During Pregnancy

Substance use often co-occurs with mental health problems including perinatal mood and anxiety disorders. Tobacco, alcohol, and drugs can have harmful effects on anyone’s health. When a pregnant or nursing woman uses these substances, her baby is also exposed to them; all substances cross the placenta through the umbilical cord and enter into the baby’s bloodstream.

While pregnant, it is best to eat well, stay healthy, and avoid ingesting anything that might be harmful to the mother’s or baby’s health. A health care provider can give you more information about these issues.

“Street” Drugs

A pregnant woman who uses drugs like cocaine, crack, heroin, and methadone may have a baby born exposed to the substances she took during her pregnancy. Cocaine is one of the most harmful drugs to unborn babies. Cocaine can cause a woman to miscarry and may cause preterm birth, bleeding, fetal death, and fetal strokes, which can lead to brain damage and death. After birth, a baby who has been exposed to cocaine prenatally goes through withdrawal, signs of which include jitters and irritability. These babies are hard to comfort and are often unable to respond to their mothers. Cocaine use during pregnancy also may be linked to an increased risk of sudden infant death syndrome, or SIDS.

Amphetamines or “speed” also are harmful to unborn babies. One study showed that the fetuses of mothers who used speed during pregnancy had decreased weight, length and head size. Another study showed that these babies had more strokes, or bleeding into their brains.


Marijuana can affect fetal and infant development and may cause miscarriage. Although the effects of marijuana on an unborn baby are still unknown, studies have indicated that prenatal marijuana use is linked to premature births, small birth size, difficult or long labor, and an increase in newborn jitteriness.

Marijuana smoked by a pregnant woman remains in the baby’s fat cells for seven to 30 days. Smoking marijuana can affect the amount of oxygen and nutrients the baby receives, which may affect growth. Marijuana is never safe during pregnancy and it can harm the baby at any stage. In addition, marijuana can have long-term effects on infants and children, such as having trouble paying attention or learning to read.


Drinking alcohol can increase the risk of miscarriage, stillbirth, newborn death, and fetal alcohol syndrome (FAS). Babies with FAS have low birth weight, heart defects, facial defects, learning problems, and developmental delays. Since it is not known if there is a safe level of alcohol during pregnancy, the best advice is not to drink at all. Even one drink a day has been shown to have effects on the growing fetus. The best time to stop drinking alcohol is before you conceive. If your pregnancy is unplanned, you should stop drinking as soon as you suspect you are pregnant.


Women who smoke during pregnancy are more likely to have babies who are small. Smoking also increases the risk of miscarriage, preterm labor, stillbirth and newborn death. Babies born weighing less than 5 pounds may have more health problems early in life and learning problems later in school. If you smoke, quit now. Ask your health care provider for information about classes or support groups for pregnant women who want to quit smoking.

Prescription Drugs

Some prescribed medications may be harmful to your unborn or nursing baby. If you are taking any prescribed drugs, tell your health care provider as soon as possible so that your medications can be changed or adjusted as needed.

Over-the-Counter Medicines and Vitamins

Avoid over-the-counter medicines such as antacids, laxatives, sleeping pills, cold medications, and pain relievers. While some are safe for pregnant women, many are not. If you feel you need any of these medications, first check with your health care provider. This applies to large doses of over-the-counter vitamin preparations as well, for taking large doses of extra vitamins can be harmful to you and your baby.


Caffeine is present in coffee, tea, cola drinks, and some medications. For at least 10 years, there has been controversy over whether caffeine is harmful during pregnancy. Some studies suggest caffeine is harmful, pointing to an increased risk of miscarriage, early delivery, or lower birth weight. Other studies have shown that women who consume a moderate amount of caffeine do not experience these problems. Because results are conflicting, no one knows the true risk. We recommend drinking as little caffeine as possible.


Ask your health care provider for more information about substances and their effects on pregnancy. Remember, your baby needs a healthy mom!

The Center for Addiction and Pregnancy (CAP) at Johns Hopkins Bayview offers an innovative approach to help mothers and infants deal with the physical, emotional, and social problems caused by addiction. CAP, an outpatient program with an available overnight housing unit for patients requiring a recovery-oriented domicile, provides a comprehensive, coordinated, and multidisciplinary approach to one of our greatest problems today: drug-dependent mothers and their drug-exposed babies.

Immediate Help

If you or a loved one needs assistance or is thinking of suicide, please get help immediately.

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