Tobacco, Alcohol, and Drugs During Pregnancy

Pregnant women should avoid tobacco, alcohol, and drug use. Even minor use carries risks for health issues in the baby, including short- and long-term conditions or even death.

The American Academy of Family Physicians (AAFP) supports education on the risks of substance use and abuse 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 prescribe treatment and/or counseling.

Path to improved health

Stop using tobacco, alcohol, and drugs if you are pregnant, trying to become pregnant, or think you may be pregnant. This is because anything you consume gets passed to the baby through your blood and the placenta. The first trimester is most critical to your baby’s development. Talk to your doctor if you need help quitting.


Smoking can increase your risk of miscarriage and preterm birth. Your baby could have a low birth weight or certain birth defects. Smoking during and/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 time to use tobacco during pregnancy. Quitting smoking improves your health and your baby’s health. You also should try to avoid secondhand smoke when you are pregnant.


Alcohol can increase your baby’s risk of major birth defects. One example is fetal alcohol disorder. It can cause problems such as slow growth, brain damage, developmental problems, and a small head.

There is no proof that drinking alcohol in a certain amount or at a certain time during pregnancy prevents these risks. Some data does suggest that limited alcohol may not pose harm to the fetus, but it is unclear how much is too much. There are not certain alcoholic drinks that are safer than others. Unless your doctor says otherwise, it is best to avoid all alcohol throughout your entire pregnancy.


Using illegal drugs, such as cocaine, heroin, and marijuana (still illegal for recreational use in most states), carry major risks. They can cause miscarriage, preterm birth, and birth defects. Your baby could be born with a drug addiction. This is called neonatal abstinence syndrome. It causes your baby to go through withdrawal, which is very painful. It often has lasting health effects.

The use of opioids during pregnancy can be harmful as well. In addition to the risks above, you could have placental abruption 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 prescribe more serious treatment. One option is 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 keep using, while others are not. They can give you a list of medicines that are proven safe. 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 good choices and going to the doctor for regular visits. You are more likely to have a healthy birth and birth. Schedule an appointment with your doctor as soon as you find out you are pregnant.

When to see the doctor

If you have a substance abuse or addiction problem, contact your doctor right away. You may need treatment. The doctor may suggest you see a counselor or psychiatrist. Other options are joining a support group, addiction program, or rehab center. 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, alcohol, and drugs?
  • Is it okay to have a small amount of alcohol during pregnancy?
  • 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?


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