Pregnancy and Addiction

The Effects of Substance Abuse on
Pregnant Women and Unborn Children

The many harmful health effects of substance abuse have been extensively studied, and millions of people are exposed to these dangers every year. In 2013, over 80 million Americans were estimated to have used tobacco, and 173 million drank alcohol. That year, over 4 million people were also estimated to have used cocaine, and more than 600,000 tried heroin.

For pregnant women who use these substances, the consequences can be even greater. Tobacco, alcohol, cocaine, and heroin use while pregnant – or even prior to pregnancy – can be harmful or fatal to the developing baby, with the potential for a lifelong impact on the child’s health. Read on to find out how these substances endanger pregnant women and their babies.

  Tobacco   Alcohol   Cocaine   Heroin


Tobacco Use and Pregnancy

Pregnancy and Tobacco

Tobacco Use and Stillbirth

zz Pregnancy, Tobacco, and Stillbirth

Smoking tobacco sharply increases the risk of stillbirth. In a study of over 25,000 pregnant women, the likelihood of stillbirth was doubled among women who smoked during pregnancy, and the risk of infant mortality nearly doubled as well. However, when women stopped smoking during the first trimester of their pregnancy, the risk of stillbirth and infant mortality decreased to that of nonsmokers, showing that quitting smoking as soon as possible can help protect a baby or unborn child’s health.


Miscarriage Associated With Tobacco Use

Pregnancy, Tobacco, and Miscarriage

The chance of miscarriage increases with the number of cigarettes smoked during pregnancy, and this risk has been directly measured. A review of 98 studies on tobacco smoke exposure and miscarriage found that for every cigarette smoked by a pregnant woman per day, the risk of experiencing miscarriage increases by 1%. Even exposure to secondhand smoke during pregnancy can elevate the chance of miscarriage by 11%. Cutting down or quitting smoking and minimizing exposure to secondhand smoke can help reduce this risk.


Tobacco Use and Placental Abruption

Pregnancy, Tobacco, and Placental Abruption

Placental abruption occurs when some or all of the placenta is pulled away from the wall of the womb, potentially leading to heavy bleeding and oxygen deprivation that can threaten the life of the mother and child. On average, placental abruption occurs in 1.7% of first pregnancies and 2.2% of second pregnancies, but smoking sharply escalates the danger; risk of placental abruption increases by 40% for every year a woman has smoked before becoming pregnant.


Tobacco and Premature Birth

Pregnancy, Tobacco, and Premature Birth

Premature birth can cause serious health complications for babies, including heart and respiratory problems, brain hemorrhage, and immune disorders. Smoking has been found to increase the risk of premature birth, and this risk grows the more a woman smokes during pregnancy. Secondhand smoke exposure elevates this risk as well, and greater exposure leads to a greater risk.


Cleft Lip, Cleft Palate, and Tobacco Use

Pregnancy, Tobacco, and Birth Defects

Cleft lip is a birth defect presenting as a split in the upper lip, potentially extending upward into the nose. Cleft palate is a similar condition that can co-occur with cleft lip, in which the roof of the mouth connects to the nasal cavity. These conditions can lead to trouble with feeding in infancy as well as dental complications, ear infections, and possible hearing loss; surgery is required to correct this. Smoking among mothers is associated with a strongly increased risk of cleft palate or cleft lip co-occurring with cleft palate.


Tobacco Usage and Low Birth Weight

Pregnancy, Tobacco, and Low Birth Weight

Low birth weight, typically defined as a weight of fewer than 5.5 pounds at birth, is associated with a greater risk of illness, infection, developmental disorders, and learning disabilities. Smoking by mothers during pregnancy is associated with a 75% greater risk of low birth weight, while reductions in smoking were linked to positive effects on birth weight.


Alcohol Use and Pregnancy

Pregnancy and Alcohol

Alcohol Use and Stillbirth

Pregnancy, Alcohol, and Stillbirth

Stillbirth, defined as the death of an unborn baby after 20 weeks of development, normally occurs in only 6.2 per 1,000 pregnancies in the U.S. However, studies have found that women who consume alcohol during pregnancy have a 40% greater likelihood of stillbirth. Notably, this risk was present for women who had any quantity of alcohol at all – even infrequent drinking can be associated with a greater chance of stillbirth.


Drinking and Likelihood of Miscarriage

Pregnancy, Alcohol, and Miscarriage

Miscarriage is the spontaneous loss of a pregnancy prior to 20 weeks of development. While this can occur in up to 20% of pregnancies, consumption of several alcoholic drinks per week – particularly in early pregnancy – can multiply this risk even further.


Fetal Alcohol Syndrome

Pregnancy, Alcohol, and FAS

Fetal alcohol syndrome is a spectrum of conditions caused by exposure to alcohol before birth. People with fetal alcohol syndrome may experience stunted growth, facial deformities, cognitive disabilities, and developmental delays. Binge drinking during pregnancy – drinking several alcoholic beverages over a short period – has the greatest chance of causing fetal alcohol syndrome in a developing baby, as high levels of blood alcohol concentration produce the greatest damage.


Drinking and Cerebral Palsy

Pregnancy, Alcohol, and Cerebral Palsy

Cerebral palsy is a range of congenital, lifelong conditions that impair bodily movement and coordination. It can vary widely in severity, and people suffering from cerebral palsy can require extensive physical therapy, speech therapy, orthotic devices, and other assistance. Cerebral palsy has a variety of possible causes, and in a study of over 23,000 babies, diagnosis of an alcohol disorder in mothers – usually indicative of heavy drinking – was associated with a higher risk of cerebral palsy in infants.


Alcohol and Low Birth Weight

Pregnancy, Alcohol, and Low Birth Weight

Low birth weight in babies is associated with a greater risk of health problems both in infancy and throughout life, and even lower levels of drinking can raise the risk of low birth weight. Women who had one or more drink per day on average during early pregnancy had more than four times the risk of having a baby with a low birth weight.


Cocaine and Pregnancy

Pregnancy and Cocaine

Cocaine and Heart Defects

Pregnancy, Cocaine, and Heart Defects

Cocaine use by pregnant women can have a damaging impact on the developing fetus. Use of cocaine is associated with developmental heart abnormalities both before and following birth, such as defects in the atria and ventricles, underdevelopment of either side of the heart, and arrhythmia (irregular heartbeat). This can occur due to the death of heart tissue in unborn babies caused by exposure to cocaine, and as these infants mature, they may remain at greater risk of injury to the heart.


Kidney Defects Associated With Cocaine

Pregnancy, Cocaine, and Kidney Defects

Kidney dysplasia is a condition of abnormal development of the kidneys during pregnancy. This impairs the kidney's ability to filter blood and produce urine, and affected kidneys are filled with cysts rather than healthy kidney tissue. This can lead to a need for dialysis or a kidney transplant, and when both kidneys are affected, infants rarely survive. Cocaine use by pregnant mothers can cause kidney dysplasia in their children.


Cocaine and Placental Abruption

Pregnancy, Cocaine, and Placental Abruption

Cocaine causes constriction of blood vessels, and in pregnant women, this can reduce the flow of oxygen to the placenta. Bingeing on cocaine is associated with placental abruption, the separation of the placenta from the uterine wall. This can endanger the life of both the mother and baby.


Premature Birth and Cocaine

Pregnancy, Cocaine, and Premature Birth

Cocaine use by pregnant women has been linked to a much higher chance of premature birth, which can lead to damage to a baby’s lungs, heart, brain, gastrointestinal system, and immune system. A review of 31 studies found that mothers who use cocaine during their pregnancy were over three times as likely to give birth prematurely.


Cocaine and Cranial Development

Pregnancy, Cocaine, and Smaller Head Circumference

Women who use cocaine heavily during pregnancy were found to have babies with a smaller head circumference compared to the rest of the infant’s body. A disproportionately smaller head size could be associated with impaired prenatal brain development.


Cocaine Use and Low Birth Weight

Pregnancy, Cocaine, and Low Birth Weight

Infants with low birth weight – fewer than 5.5 pounds – are vulnerable to a host of health problems over their lifetime. A review of several studies found that mothers who used cocaine during pregnancy were over three times as likely to have babies with a low birth weight.


Heroin and Pregnancy

Pregnancy and Heroin

Needle Sharing and Infectious Diseases

Pregnancy, Heroin, and Disease

Heroin users often inject the drug, and may share already-used needles with others. These used needles are contaminated with blood, and when reused, they can transmit blood-borne infectious diseases such as HIV and hepatitis. In pregnant women, infections with HIV and the hepatitis B virus can be passed to the developing baby. HIV, the virus that causes AIDS, impairs immune function and can require lifelong treatment, while hepatitis B can result in severe illness in infants, liver damage or failure, and even death.


Heroin and Stunted Growth

Pregnancy, Heroin, and Intrauterine Growth Restriction

Use of heroin by pregnant women can produce unhealthy structural changes in the placenta and umbilical cord, which supply the developing baby with oxygen and nutrients. Due to these changes, babies born to women who used heroin during pregnancy are more likely to be born prematurely, putting them at risk for a variety of negative health outcomes. Babies of heroin-using mothers are also more than four and a half times as likely to be born at a low birth weight.


Heroin and Neonatal Abstinence Syndrome

Pregnancy, Heroin, and NAS

Heroin is a highly addictive drug, and symptoms of withdrawal can affect the newborn babies of heroin-using mothers. This neonatal abstinence syndrome can include symptoms such as irritability, tremor, poor feeding reflexes, impaired ability to regulate body temperature, and even seizures. This can last for several weeks and require medical treatment.


Getting Help for Substance Addiction

Illicit drug use by pregnant women can harm an unborn baby’s development in a variety of ways, potentially resulting in severe and lifelong health complications and disabilities. And even legal substances such as alcohol and tobacco can cause extensive impairment and serious illness in children when used by pregnant women. Fortunately, quitting these substances may reduce some of the risks posed to unborn babies.

If you or someone you know is seeking help for substance use or dependence, contact’s helpline at 1-888-993-3112Who Answers?, or peruse our national treatment directory to find a comprehensive and specialized treatment program, including treatment for pregnant women. Visit for more information on how you can take steps to protect your health – and your baby’s.

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Tobacco Use and Pregnancy - Alternate

Pregnancy and Tobacco

Tobacco Use and Stillbirth - Alternate

Pregnancy, Alcohol, and Stillbirth

Miscarriage Associated With Tobacco Use - Alternate

Pregnancy, Alcohol, and Miscarriage

Alcohol Use and Pregnancy - Alternate

Pregnancy and Alcohol

Alcohol Use and Stillbirth - Alternate

Pregnancy, Alcohol, and Stillbirth

Drinking and Likelihood of Miscarriage - Alternate

Pregnancy, Alcohol, and Miscarriage

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