Substance abuse in pregnancy

Substance misuse during pregnancy adversely affects both medical and social outcomes. Consequently women with problem drug and/or alcohol use have potentially high-risk pregnancies. Their management should therefore be obstetrically led, but much of their care can be delivered by midwives. Such women also have difficulties in attending appointments, so it is important that they are provided with multidisciplinary care, preferably community based, that addresses all of their medical and social problems within a single service. The aim of management is stability rather than abstinence and objectives should be realistic and achievable. Although important for all women, continuity in reproductive healthcare provision is vital for this vulnerable group of women. This will enable them to protect and control their fertility, to have pregnancies if and when they choose and to achieve the best possible outcomes.