Tobacco, Alcohol, and Drugs During Pregnancy

Pregnant people should avoid using tobacco, nicotine, alcohol, and drugs. Even minor use carries health risks for the baby, including short- and long-term conditions.

The American Academy of Family Physicians (AAFP) supports education on the risks of substance use and misuse during pregnancy. The AAFP also recommends that adults who are 18 years or older be screened for alcohol misuse. For people who appear to have a problem, physicians should provide brief intervention, prescribe treatment and refer to counseling.

Path to improved health

Stop using tobacco/nicotine, alcohol, and drugs if you are pregnant, trying to become pregnant, or think you may be pregnant. Harm may occur at any time during pregnancy. Talk to your doctor if you need help quitting.

Tobacco/Nicotine

Smoking can increase your risk of miscarriage and preterm birth. Your baby could have a low birth weight or certain birth defects. Smoking during or after pregnancy also has been linked to sudden infant death syndrome (SIDS).

Other tobacco products, such as e-cigarettes, carry the same risks as smoking. There is no safe amount of tobacco or nicotine at any time in your pregnancy. Quitting smoking improves your health and your baby’s health. You should also avoid secondhand smoke when pregnant.

Alcohol

Alcohol use during pregnancy can cause birth defects and result in fetal alcohol spectrum disorders (FASDs). FASDs are a group of conditions that can occur in a person who was exposed to alcohol during pregnancy. The effects can include physical problems and problems with behavior and learning. Often a person has a mix of these problems.

There is no known safe amount, type or time to drink during pregnancy.

Drugs

Using recreational drugs such as cocaine, opioids, amphetamines (heroin/fentanyl), and cannabis carry major risks. They can cause miscarriage, preterm birth, and birth defects. Your baby could go through drug withdrawal shortly after birth. This is called neonatal abstinence syndrome, which is very painful. It often has lasting health effects.

The use of opioids during pregnancy can be harmful as well. You could have placental abruption (the placenta separates early from the uterus), or your baby could have fetal growth problems. If you take opioids for a medical issue, talk to your doctor about when and how to quit. If you have an opioid addiction, your doctor may provide medication-assisted therapy (MAT).

Once you know you’re pregnant, talk to your doctor about all the medicines you take. Some prescription and over-the-counter (OTC) drugs are okay to use, while others are not. For some medicines, you may need to switch the dosage or type. Do not stop or start using a new drug without talking to your doctor first. This includes vitamins and supplements.

Things to consider

It is very important to maintain a healthy lifestyle while you are pregnant. This includes making healthy choices like going to the doctor for regular visits and ensuring you are getting proper nutrition. This will make you more likely to have a healthy birth. Schedule an appointment with your doctor as soon as you find out you are pregnant.

If you have a substance use or addiction problem, contact your doctor right away. You may need treatment. The doctor may suggest you see a counselor, psychiatrist or other specialist. If the doctor has specific concerns about your baby, they may order an ultrasound or other test.

Questions to ask your doctor

• At what point should I stop using tobacco/nicotine, alcohol, and drugs?
• When can I start having alcohol again?
• Can I start smoking again once the baby is born?
• Can I take prescription drugs while I am pregnant?
• Can I take over-the-counter drugs while I am pregnant?

Resources

American Academy of Family Physicians: Taking Care of You and Your Baby While You’re Pregnant

American Academy of Family Physicians: OTC Medicines and Pregnancy

CDC: Alcohol and Pregnancy