Substance misuse in pregnancy

Substance misuse is a common problem complicating pregnancy and childbirth. Multidisciplinary care is necessary to optimize outcomes, because the financial, psychological, social and domestic problems associated with drug misuse are often of greater importance than the physical and medical concerns. A specialist midwife is ideally placed to coordinate the involvement of acute hospital trusts, community midwives, general practitioners, mental health and drug services, social services and sometimes the police. The aim during pregnancy is to engage the client with these multiple agencies, to help bring a degree of order, and to reduce the harm associated with substance misuse. Abstinence and detoxification are not necessarily the priority. This review illustrates the general principles of managing substance misuse in pregnancy using three case scenarios covering both drug and alcohol misuse.