Drug use in pregnancy can slow your baby’s growth, raise the risk of miscarriage, stillbirth and preterm birth, and leave a newborn going through withdrawal. Alcohol, nicotine, marijuana, opioids and stimulants all reach the baby. If you’re pregnant and using, the most important thing you can do is tell your prenatal provider. And if you’re dependent on opioids, alcohol or benzodiazepines, don’t stop suddenly on your own. Quitting abruptly can be dangerous for both of you.
You’re not the only one in this spot. According to NIDA, about 5% of pregnant women use one or more addictive substances, and many are too scared to say so. Telling the truth to your doctor or midwife is how you get care that actually protects your baby.
What Happens When You Use Drugs While Pregnant
What you take in, your baby takes in. How much harm it does depends on the substance, how much and how often you use, and when in pregnancy the exposure happens. NIDA reports that stillbirth risk is 1.8 to 2.8 times higher with tobacco use and 2.3 times higher with marijuana use. The substances below are the most common.
Alcohol
The CDC is blunt about this one: there’s no known safe amount of alcohol during pregnancy, no safe time to drink and no safe type. Wine and beer carry the same risk as liquor. Alcohol can cause fetal alcohol spectrum disorders (FASDs), which affect movement, learning, behavior and emotional control for life. If you drink heavily or every day, though, don’t just stop. Talk to a doctor first, because alcohol withdrawal can be dangerous.
Tobacco and nicotine
Smoking raises the risk of birth defects, premature birth, miscarriage and low birth weight. NIDA notes that nicotine levels in the baby’s blood can run up to 15% higher than in the mother’s. Secondhand smoke is linked to premature birth, low birth weight and SIDS, so the people you live with matter too.
Marijuana
Legal doesn’t mean safe in pregnancy. The American College of Obstetricians and Gynecologists, as cited by NIDA, recommends avoiding marijuana while trying to conceive, during pregnancy and while breastfeeding. It’s associated with low birth weight. Use is climbing: past-month use among pregnant women rose from 3.4% in 2002 and 2003 to 7.0% in 2016 and 2017, according to NIDA. Plenty of women use it for morning sickness. Ask your provider about safer options.
Opioids: prescription painkillers, heroin and fentanyl
Opioids cross the placenta and can make the baby physically dependent. After birth, the baby may go through withdrawal, called neonatal abstinence syndrome (NAS). NIDA lists excessive crying, irritability, seizures and stomach problems, and says symptoms can show up right away or as late as 14 days after birth. Short-acting prescription opioids like oxycodone are linked to a higher likelihood of NAS, especially combined with tobacco.
Here’s the part that surprises people: stopping opioids suddenly is also risky. MedlinePlus warns that stopping suddenly can be dangerous to you and the baby. Doctors often treat opioid use disorder in pregnancy with medication such as methadone or buprenorphine, which keeps withdrawal and cravings in check. Your care team will plan for your baby’s care after birth too.
Cocaine and methamphetamine
Cocaine raises the risk of placental abruption (the placenta pulling away from the uterus), preterm labor and dangerous spikes in blood pressure. Methamphetamine is linked to preeclampsia, premature delivery, placental abruption and low birth weight, NIDA reports.
Benzodiazepines and other prescriptions
If you take a prescribed medicine, including anxiety medications like Xanax or Klonopin, don’t stop on your own when you find out you’re pregnant. Benzodiazepine withdrawal can cause seizures. MedlinePlus advises discussing the risks and benefits with your provider. Misusing a prescription carries its own risks, which depend on the drug.
What If I Used Drugs Before I Knew I Was Pregnant?
This is incredibly common. Lots of women don’t know they’re pregnant for several weeks. Try not to panic, and don’t let guilt keep you from telling your provider. They can talk through what that exposure means for your situation and what to watch for. Stopping now, safely, still helps your baby.
How Drug Use Affects the Baby After Birth
Babies exposed to opioids, alcohol and some other drugs may be jittery, hard to settle, poor feeders or bad sleepers in the first days and weeks. The risk of sudden infant death goes up too. NIDA reports that babies whose mothers both drank and smoked past the first trimester had a twelvefold higher SIDS risk. Some substances also pass into breast milk, so ask about breastfeeding before your baby arrives.
If You’re Pregnant and Addicted
- Tell your prenatal provider what you’re using and how much. You’ll get better care, not worse.
- Don’t quit opioids, alcohol or benzodiazepines cold turkey. Ask for medical help to stop safely.
- Ask about medication for opioid use disorder if opioids are part of the picture.
- Keep every prenatal appointment, even the ones you dread.
- Get addiction treatment that knows you’re pregnant, and bring your provider into the plan.
- In an emergency (overdose, seizure, heavy bleeding, trouble breathing) call 911. If you’re unsure whether something you took is dangerous, call Poison Control at 1-800-222-1222.
Fear of judgment keeps a lot of women from asking for help. Your provider’s job is to keep you and your baby healthy, and they can’t do it without the truth. If depression or anxiety sits underneath your use, ask about co-occurring treatment as well.
Getting Addiction Treatment During Pregnancy
Covenant Hills is a Christian treatment center with two tracks, a faith-based track and a traditional one, and a dedicated women’s treatment program. Detox happens under medical care, never cold turkey. If you’re pregnant, tell us when you call. Pregnancy changes what safe treatment looks like, and we’ll help you find the right next step, including care somewhere else if that’s the better fit.
Call 800-662-2873 for a free, confidential assessment.
Frequently Asked Questions
Which drugs are most harmful during pregnancy?
There’s no single answer. Alcohol has no known safe amount and can cause lifelong FASDs. Opioids can cause newborn withdrawal. Tobacco, cocaine and meth raise the risk of preterm birth, placental problems and low birth weight. The safest amount of any of them is none, reached with medical help.
Can I stop using drugs cold turkey while pregnant?
Not with every drug. Suddenly stopping opioids can be dangerous for you and your baby, and stopping alcohol or benzodiazepines after heavy use can cause dangerous withdrawal. Talk to your provider before you stop.
Will my baby go through withdrawal?
It’s possible, especially with opioid exposure. Symptoms can start right after birth or up to 14 days later. Hospitals know how to watch for and treat newborn withdrawal, so tell your care team what you’ve used.
Is marijuana safe during pregnancy if it’s legal?
No. Legal status doesn’t change how THC affects a developing baby. Obstetricians recommend avoiding marijuana while trying to get pregnant, during pregnancy and while breastfeeding.
