It is important to discuss all 

medications, both prescribed and over 

the counter, with your doctor during 

pregnancy and breastfeeding.

Alcohol use 

 No amount of alcohol use during pregnancy or while 

trying to get pregnant is safe 

 All types of alcohol are equally harmful, including all 

wines and beer 

 The baby’s brain is developing throughout pregnancy 

and even small amounts of alcohol can result in Fetal 

Alcohol Spectrum Disorders (FASD), which are brain 

disorders related to alcohol use

 The effects of alcohol can last throughout your baby’s 

life, causing difficulties with motor coordination, 

emotional control, schoolwork, socialization and 

holding a job

Tobacco use 

 Smoking may have an impact on fertility

 Nicotine causes blood vessels to narrow, so less 

oxygen and fewer nutrients reach your baby

 Nicotine also damages a baby’s brain and lungs – this 

damage is permanent

 There is a greater risk of stillbirth, with the highest risk 

found among the heaviest smokers

E-cigarettes contain harmful nicotine 

and are not safe substitutes for 

cigarettes and should not be used 

during pregnancy. 

What about secondhand smoke?

 Secondhand smoke can increase the risk of having a low birth 

weight baby – a low birth weight puts the baby at risk for poor 

health later in life

 Babies who are exposed to secondhand smoke have an increased 

risk of Sudden Infant Death Syndrome (SIDS)

 Babies who are exposed to secondhand smoke are more likely to 

have asthma attacks and ear infections 

 There is a 2.1 times greater risk of stillbirth when you are exposed 

to secondhand smoke

Opioid use 

 Opioids are a type of medication that relieves pain and include 

oxycodone, hydromorphone, hydrocodone and codeine 

 You and your doctor should discuss the risks and benefits of opioid 

medications prior to and during pregnancy and after childbirth

 When taken under a doctor’s care, opioids are safe for both you 

and your baby 

 It is important to take the medication only as prescribed 

When you are pregnant and have an opioid addiction, 

you should not suddenly stop using the drug without 

medical supervision. Withdrawal, especially when 

done abruptly, often leads to relapse, which can be 

harmful for you and your baby. 

Illegal drug use 

 Illegal drugs or misuse of prescription drugs can 

interfere with the growth of the baby and cause birth 

defects, preterm birth and miscarriage

 Babies can become addicted to cocaine, heroin, 

methamphetamines and other drugs

 If born addicted, the type and severity of your baby’s 

withdrawal symptoms depend on the drug(s) used, 

how long and how often you used the drugs, how your 

body breaks the drug down, and whether the baby 

was born full term or prematurely

What about marijuana?

 The American College of Obstetricians and 

Gynecologists recommends against using marijuana 

while trying to get pregnant, during pregnancy and 

while you are breastfeeding

 Smoking marijuana might increase the levels of carbon 

monoxide and carbon dioxide in the blood, which may 

reduce the oxygen supply to your baby

 There is an increased risk of your baby having a low 

birth weight when you smoke marijuana 

Where can I get help to reduce or stop 

using tobacco, alcohol, illegal drugs or 

prescription medication(s)?

There are many beneficial treatments available for 

service members and their family members. Talk with 

your obstetrician or other health care provider about 

what treatment options are available and what will be 

most helpful for you and your baby. 

The treatment that is best for you 

depends on the substance you are 

using, your personal characteristics and 

your preferences. 
References

1 Management of Pregnancy Work Group. Department of 

Veterans Affairs & Department of Defense. (2018). VA/

DoD Clinical Practice Guideline for the Management of 

Pregnancy. Version 3.0. Retrieved from https://www.

healthquality.va.gov/guidelines/WH/up/

2 Management of Substance Use Disorders Work Group. 

Department of Veterans Affairs & Department of Defense. 

(2015). VA/DoD Clinical Practice Guideline for the 

Management of Substance Use Disorders. Version 3.0. 

Retrieved from https://www.healthquality.va.gov/guidelines/

MH/sud/

3 Management of Opioids for Chronic Pain Work Group. 

Department of Veterans Affairs & Department of Defense. 

(2017). VA/DoD Clinical Practice Guideline for the 

Management of Chronic Pain. Version 3.0. Retrieved from 

https://www.healthquality.va.gov/guidelines/Pain/cot/

VADoDOTCPG022717.pdf

4 American College of Obstetricians and Gynecologists. 

Tobacco, Alcohol, Drugs and Pregnancy Frequently Asked 

Questions. (2017). Retrieved from: https://www.acog.org/

Patients/FAQs/Tobacco-Alcohol-Drugs-and-Pregnancy

5 National Institute on Alcohol Abuse and Alcoholism. Fetal 

Alcohol Exposure Fact Sheet. (2015). Retrieved from 

https://pubs.niaaa.nih.gov/publications/FASDFactsheet/

FASD.pdf 

6 Centers for Disease Control and Prevention, National Center 

on Birth Defects and Developmental Disabilities. (2018). 

Alcohol Use in Pregnancy. Retrieved from: https://www.cdc.

gov/ncbddd/fasd/alcohol-use.html

DoD/VA Resources

The Purple Book

A complete guide to pregnancy in the Department of Veterans 

Affairs and the Department of Defense 

https://www.qmo.amedd.army.mil/pregnancy/PurpleBook.pdf

Military OneSource

Provides 24/7 support and information on housing, financial, 

legal, medical and psychological services

Stateside 800-342-9647 

Overseas 800-3429-6477

or collect 484-530-5908

www.militaryonesource.mil

My HealtheVet 

An online system for Veterans to manage and track their health care

www.myhealth.va.gov

Psychological Health Center of Excellence 

Provides policies and evidence-based information and resources on 

psychological health

http://www.pdhealth.mil/resource-center

External Resources

Centers for Disease Control and Prevention

Provides current evidence-based medical recommendations

https://www.cdc.gov/pregnancy/index.html

National Institute on Drug Abuse

Provides research and resources on the causes and consequences of drug 

use and addiction

www.drugabuse.gov

National Institute on Alcohol Abuse and Alcoholism

Provides information on treatment for alcohol addiction and fetal alcohol 

exposure

www.niaaa.nih.gov

Clinical Guidance for Treating Pregnant and Parenting Women With 

Opioid Use Disorder and Their Infants 

This guide provides national guidance for the management of pregnant and 

parenting women with opioid use disorder

Substance Abuse and Mental Health Services Administration HHS Publication 

No. (SMA) 18-5054. Rockville, MD. 2018. 

www.samhsa.gov

The American College of Obstetricians and Gynecologists

Provides medical information on tobacco, alcohol, drugs and pregnancy

https://www.acog.org/Patients

The guideline is available at https://www.healthquality.va.gov. Army, Navy 

and Air Force facilities can order copies of this brochure and guideline at 

https://www.qmo.amedd.army.mil

PUID 4840

Updated September 2018 by the Psychological Health 

Center of Excellence (PHCoE)

Department of Veterans Affairs and Department of 

Defense employees who use this information are 

responsible for considering all applicable regulations 

and policies throughout the course of care.