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Tobacco, Alcohol, Drugs and Pregnancy

Some women need to quit smoking, avoid alcohol, or stop the use of some drugs during pregnancy. These changes, along with regular prenatal care, are key to having a healthy pregnancy and a healthy baby.

Advice about changing behavior and treatment for problems with substance use are available. Help often is just a phone call or click away.

This pamphlet explains

  • how smoking, alcohol, and illegal drugs can affect pregnancy
  • signs that you may have a substance abuse problem
  • how to get help
  • safe use of prescription and over-the-counter medications


If a woman smokes when she is pregnant, her baby is exposed to harmful chemicals such as tar, nicotine, and carbon monoxide. Nicotine causes blood vessels to constrict, so less oxygen and nutrients reach the fetus. Carbon monoxide decreases the amount of oxygen the baby receives. In addition to risks to her own health, several problems are more likely to occur during pregnancy if a woman smokes. These include preterm birth and problems with the way the placenta attaches to the uterus. Infants born to women who smoke during pregnancy tend to be smaller than those born to nonsmokers. They are more likely to have asthma, colic, and childhood obesity. They also have an increased risk of dying from sudden infant death syndrome (SIDS).

Secondhand smoke—smoke from cigarettes smoked by other people nearby—can be harmful as well. Breathing secondhand smoke during pregnancy increases the risk of having a low birth weight baby by as much as 20%. Infants who are exposed to secondhand smoke have an increased risk of SIDS and are more likely to have respiratory illnesses than those not exposed to secondhand smoke.

For all of these reasons, it is best to stop smoking before pregnancy or as soon as you find out you are pregnant. Stopping smoking during pregnancy is better than not stopping at all. It is unclear whether cutting down on the amount that you smoke has any benefits. Quitting completely is best for you and your baby. You even may be able to quit for a lifetime. You and your family will be healthier as a result.

If you are pregnant and you smoke, tell your health care provider. He or she can help you find support and quitting programs in your area. You also can call the national “quit line” at 1-800-Quit-Now.

Although many smokers quit with the help of nicotine replacement (such as nicotine gum or the patch) or prescription medications, these aids need to be used with caution during pregnancy. Not enough tests have been done to determine their safety during pregnancy. Over-the-counter nicotine replacement products should be used only if other attempts to quit have not worked and you and your health care provider have weighed the known risks of continued smoking against the possible risks of these products. Smokeless tobacco, electronic cigarettes, and nicotine gel strips are not safe substitutes for cigarettes. They should not be used to quit smoking.

If you live or work around smokers, take steps to avoid secondhand smoke. You may want to ask family members who smoke to smoke outside or quit altogether.

Once the baby is born, it can be tempting to start smoking again. Be prepared. Before the baby is born, think about how you will handle wanting to smoke and have a plan in place to avoid smoking. Talk with your health care provider about your plan to remain smoke-free.

Do You Have a Drinking Problem?

Do you use alcohol or abuse it? Sometimes it is hard to tell. If you are not sure, ask yourself these questions:

T How many drinks does it take to make you feel high? (TOLERANCE)

A Have people ANNOYED you by criticizing your drinking?

C Have you felt you ought to CUT DOWN on your drinking?

E Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (EYE OPENER)


2 points if your answer to the first question is more than two drinks.

1 point for every “yes” response to the other questions.

If your total score is 2 or more, you may have an alcohol problem. Talk to your health care provider about your drinking habits. He or she can help you decide if you have a problem and refer you for counseling or treatment if needed. You also may want to think about contacting a substance abuse program. These groups can help you find someone to talk to about your problem and give you needed support when you are trying to quit. Check your local yellow-page listings or the Internet.

Modified from Sokol RJ, Martier SS, Ager JW. The T-ACE questions: practical prenatal detection of risk drinking. Am J Obstet Gynecol 1989;160:865.


Alcohol is a substance that can interfere with the normal growth of a fetus and cause birth defects. Alcohol is more harmful to a fetus than it is to an adult. When a pregnant woman drinks alcohol, it quickly reaches the fetus through the placenta. In an adult, the liver breaks down the alcohol. A baby’s liver is not fully developed and is not able to break down alcohol.

“Fetal alcohol spectrum disorders” is a term that describes different effects that can occur in the fetus when a woman drinks during pregnancy. These effects may include physical, mental, behavioral, and learning disabilities that can last a lifetime. The most severe disorder is fetal alcohol syndrome (FAS). FAS can cause growth problems, mental or behavioral problems, and abnormal facial features. It is most likely to occur in infants whose mothers drank heavily (3 or more drinks per occasion or more than 7 drinks per week) and continued to drink heavily throughout pregnancy, but it also can occur with lesser amounts of alcohol use. Even moderate alcohol use during pregnancy (defined as one alcoholic drink per day) can cause lifelong learning and behavioral problems in the child.

There is no safe level of alcohol use during pregnancy. Alcohol can affect the fetus throughout pregnancy. It is best not to drink at all while you are pregnant. If you did drink alcohol before you knew you were pregnant, you can reduce the risk of further harm to the baby by stopping drinking. It is unlikely that drinking a small amount of alcohol very early in pregnancy will cause serious birth defects.

If it is hard for you to stop drinking, you may have a drinking problem. Talk with your health care provider about your drinking habits (see box “Do You Have a Drinking Problem?”). If you are dependent on alcohol, you may need specialized counseling and medical care (see the “Substance Abuse and Addiction” section for more information).

Drug Use and Abuse

Illegal drugs include heroin, cocaine, methamphetamines, marijuana, and prescription drugs used for a nonmedical reason. Drug abuse is a widespread problem in the United States. It is estimated that up to 40% of pregnant women have used one of these substances during pregnancy. Often, more than one substance is used.

Different drugs may affect the fetus in different ways. A drug’s effect on the fetus depends on many things: how much, how often, and when during pregnancy it is used. The early stage of pregnancy is the time when main body parts of the fetus form. Using drugs during this time in pregnancy can cause birth defects and miscarriage. During the remaining weeks of pregnancy, drug use can interfere with the growth of the fetus and cause preterm birth and fetal death. Drugs used after the baby is born can be passed to the baby through breast milk. Infants born to women who used illegal drugs during pregnancy may need specialized care after birth and have an increased risk of long-term medical and behavioral problems.

Your health care provider may ask about your use of all drugs and medications throughout your pregnancy. It is important to be honest so that you get the help you need for yourself and your unborn baby. Drug testing of your hair or urine during pregnancy or during labor may be done if your health care provider suspects that you have used certain substances and if you have a complication during pregnancy or delivery that suggests drug use. The baby also can be tested after birth.

Some states consider drug use during pregnancy to be a form of child abuse. In some states, if a drug test result shows that you have used certain substances, it must be reported to state authorities. You should be informed about this testing and consent to it before it is done. How your consent is obtained also varies from state to state.

How to Get Help

The groups listed below help people with drug abuse. If you or someone you know has a drug problem, seek help.

Alcoholics Anonymous
Web site: www.aa.org
To find an AA meeting, telephone numbers for Alcoholics Anonymous often are listed in local telephone directories. You also can search online for “Alcoholics Anonymous” and the name of your city or region to find a local AA web site.

Narcotics Anonymous
NA World Services Office
PO Box 9999
Van Nuys, California 91409
Telephone: 818-773-9999
Web site: www.na.org
To find an NA meeting, telephone numbers for Narcotics Anonymous often are listed in local telephone directories. You also can search online for “Narcotics Anonymous” and the name of your city or region to find a local NA web site.

Substance Abuse and Mental Health Services Administration (SAMHSA)
24-hour Treatment Referral Line Telephone: 800-662-HELP (4357)
Web site: www.samhsa.gov
SAMHSA provides a treatment locator service for substance abuse as well as mental health disorders and issues.

Substance Abuse and Addiction

A person who abuses alcohol or drugs has repeated problems related to her substance use. These problems include work, relationship, and family issues; drunk-driving arrests and car crashes; or medical problems caused by the substance. Substance abuse can lead to dependence (addiction). Addiction is a disease with three or more of the following signs and symptoms:

  • Tolerance—Not having the same effect with continued use of the same amount and the need to use greater amounts of the substance to get “high”
  • Withdrawal symptoms after stopping use of the substance
  • Using larger amounts of the substance or using it over a longer period
  • Desire or unsuccessful attempts to cut down or control substance use
  • Spending a great deal of time using or obtaining the substance or recovering from its use
  • Reducing or giving up important social, work, or recreational activities because of substance use
  • Continuing to use the substance despite knowing that you have a problem
  • Making excuses to continue using the drug instead of meeting your home or work responsibilities

Usually, people who are addicted to a drug cannot quit by themselves. Treatment is needed to end the addiction. For pregnant women who are addicted to certain drugs, including pain medications and narcotics, treatment is especially important. Withdrawal from these drugs can cause miscarriage or other harm to the fetus.

Addiction treatment often involves medical and behavioral support. Treatment programs help people to look at the reasons for their drug use, to know that they are not alone, and to find new ways to cope. Recovery can take a long time, and there can be setbacks along the way. Success depends on finding the right program and making a commitment to seeing it through (see box “How to Get Help”).

Prescription and Over-the-Counter Medications

All medications—including prescription, over-the-counter, and herbal medications—can potentially affect the fetus. This does not mean that you should stop taking all medications once you are pregnant. It does mean that you need to be careful. By following a few guidelines, you can safely use some medications during pregnancy and avoid others that may pose risks during pregnancy.

Prescription Medications

Some prescription medications are safe to take during pregnancy. Others have known risks. For many other medications, the risks to the fetus are not known. If you are taking a prescription medication and become pregnant, tell your health care provider. Do not stop taking a medication prescribed for you without first talking to your health care provider. If a medication you are taking poses a risk, your health care provider may recommend switching to a safer drug while you are pregnant or adjusting the dosage.

Over-the-Counter Medications

Medicines sold over the counter, including herbal supplements and vitamins, can cause problems during pregnancy. Pain relievers such as aspirin and ibuprofen may be harmful to a fetus. Check with your health care provider before taking any over-the-counter drug. He or she can give you advice about medicines that are safe for pregnant women.


Taking good care of yourself during pregnancy helps ensure you are taking good care of your baby. Stay healthy by not smoking, drinking alcohol, or taking drugs. Making healthy choices now will help give your baby a healthy start.


Fetal Alcohol Syndrome (FAS): A pattern of physical, mental, and behavioral problems in the baby that are thought to be due to alcohol abuse by the mother during pregnancy.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Miscarriage: Loss of a pregnancy that occurs before 20 weeks of pregnancy.

Nutrients: Nourishing substances supplied through food, such as vitamins and minerals.

Oxygen: A gas that is necessary to sustain life.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Born before 37 weeks of pregnancy.

Sudden Infant Death Syndrome (SIDS): The unexpected death of an infant in which the cause is unknown.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.