Substance use and misuse in pregnancy

The potential for harm from the use or abuse of substances such as drugs, tobacco and alcohol is particularly acute during pregnancy and can have a severe and damaging impact on pregnancy and the health of the baby. Substance misuse can significantly harm a foetus, yet pregnancy can act as an equally strong incentive to make a positive change in behaviour and lifestyle. It is important that this is both recognised and supported by early years and health practitioners who work with pregnant women.

Substance use and misuse, tobacco use and inequalities in pregnancy

Drug and alcohol misuse and tobacco use before and during pregnancy are major risk factors for miscarriage, maternal and infant death, and health inequalities. Some forms of substance use and misuse are more common among disadvantaged groups.

There is good evidence that early interventions can improve outcomes.

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What are health inequalities?

Health inequalities are avoidable differences in health status or determinants between population groups.

‘To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.’ Marmot Review (external link)

Inequalities are usually the result of a complex matrix of lifestyle choices, personal history and circumstances, and access to services.

How do inequalities impact on health in Scotland?

Inequalities begin before birth, can adversely impact health throughout adult life, and can persist across generations.

In Scotland in 2005-06, healthy life expectancy at birth was 67.9 years for men and 69 years for women. Meanwhile, in the most deprived 15% of areas, healthy life expectancy at birth was 57.3 years for men and 59 years for women (from Equally Well).

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Policy context

Activity in this area is consistent with Equally Well and the following (external links):

How do inequalities relate to substance use and misuse in pregnancy?

  • 40% of adults in the most deprived deciles smoke compared to 23% in Scotland overall. (Scottish Household Survey 2011 - external link)
  • In 2010/11, 31.6% of mothers in the most deprived fifth of the population in comparison with 6.0% in the least deprived fifth were smokers at booking appointment (ISD Scotland - external link)

  • In 2009/10, Almost half of the births recording drug misuse were recorded as being in the fifth deprivation category (most deprived). (ISD Scotland - external link)

Women from vulnerable groups are less likely to access antenatal services and other sources of support - a high risk factor for maternal and infant mortality.

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What are the risks from substance use and misuse in pregnancy?

Common risks for drugs, alcohol and tobacco include:

  • complications in pregnancy and labour
  • maternal death
  • miscarriage
  • premature birth
  • stillbirth
  • infant death
  • low birth weight
  • Sudden Infant Death Syndrome

Where drug or alcohol misuse occurs:

  • withdrawal symptoms in infants
  • physical and neurological damage to the baby
  • Foetal Alcohol Spectrum Disorder

Women who inject drugs who share injecting equipment risk infection with Blood Borne Viruses, which may be passed to the baby.

Children born to smokers are more likely to suffer from asthma, chest, inner ear and other infections, and to become a smoker in later life.

Identifying those at risk from drug and alcohol misuse

Fear of prosecution or that their baby or other children will be taken away may make women who misuse substances or who drink to excess reluctant to contact antenatal services. (Hidden harm - Next Steps: Supporting Children - Working with Parents (external link))

Particularly in first pregnancies, it's important to link with other professionals who may know more about the family and their circumstances, e.g. carers, GPs, social workers, the police and voluntary sector agencies.

For a fuller discussion of risk factors, see Inequalities in Antenatal Care.

A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.

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Identifying those at risk from tobacco use and second hand smoke

Where smoking habits are unknown, it should suffice simply to ask whether the mother or her partner smokes or not, before providing appropriate advice. However, use of a cabon monoxide monitor is an objective measurement and is a useful tool for leading on to a discussio about smoking and second-hand smoke exposure, particularly if the reading indicates that smoking or exposure tosecond hand smoke is taking place. This is now becoming routine practice in Scotland around the time of the first booking appointmnet into antenatal services.

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Articles in this topic



Professional support materials

Information for the public

  • External Resource

    Alcohol and pregnancy

    The Foetal Alcohol Spectrum Disorders (FASD) Trust works to raise awareness of the effects of alcohol on developing children.

    • When was this published? 8/18/2010
  • External Resource

    Can stop smoking

    This is the national stop smoking website, which offers information on free stop smoking support in local areas throughout Scotland.

    • When was this published? 9/27/2010
  • External Resource


    This publication from NHS Health Scotland gives information about stopping smoking when you're pregnant.

    • When was this published? 8/18/2010
  • External Resource

    My Pregnancy My Choice

    Book for expectant parents with learning disabilities. This book is available free of charge to Early Years professionals in Scotland from NHS Health Scotland as an alternative to Ready Steady Baby! To order contact

    • When was this published? 5/27/2013
  • External Resource

    Ready Steady Baby!

    A website for the public providing information and advice through pregnancy and the baby's first days.

    • When was this published? 8/18/2010
  • External Resource

    REFRESH website

    The refresh website offers advice for parents and professionals on how to reduce children's exposure to second-hand smoke.

    • When was this published? 9/2/2013
  • External Resource


    Smokeline provides a free and confidential information and advice service to Scottish smokers who wish to stop or to support ex-smokers who want to stay stopped.

    • When was this published? 5/6/2013
  • External Resource

    Women and alcohol [819KB]

    This leaflet aimed at the public covers the issues surrounding women and alcohol, in particular regarding pregnancy, breastfeeding and gender-based violence within the home.

    • When was this published? 8/18/2010