Substance misuse in pregnancy is a complex issue requiring multi-agency working between drugs agencies and obstetric services.

The Confidential Enquiries into Maternal Deaths (2000-2002) found that, when all deaths up to 1 year from delivery were taken into account, psychiatric illness was not only the leading cause of indirect death, but also the leading cause of maternal deaths overall.

Moreover, misuse of alcohol and illicit substances during pregnancy has been associated with significant obstetric maternal, fetal and neonatal complications. These include low birth weight, prematurity, fetal alcohol syndrome, fetal loss, and antepartum haemorrhages. Substance misuse also increases the risk for other conditions, for example, sexually transmitted diseases, hepatitis B, hepatitis C, HIV, and domestic violence. These associated problems can present significant risk to the pregnant mother and her unborn child in themselves.

The National Treatment Outcome Study has provided substantial evidence that treatment for adult drug misuse does work in that it reduces drug use, improves health and reduces criminality which benefits individuals, families and communities. Data from our multidisciplinary PDU service demonstrated that there was a statistically significant association between antenatal attendance at the PDU clinic and birth weight centile possibly by enhancing the much needed stability in the often chaotic lives of these young women since it gives them the opportunity not only for substitute medication but also to resolve housing, employment and other social issues and so limit the untoward effects of these factors on pregnancy outcomes.