Alcohol and other drug use during pregnancy can have detrimental effects -- both specific and nonspecific -- on the perinatal outcome. Specific effects of alcohol use can include facial dysmor- phology and organ system anomalies, such as alcohol- related birth defects. Pregnant women who use alcohol and other drugs are at an increased risk for preterm labor, thereby placing an already compromised fetus at increased risk. Nonspecific effects can include fetal growth retardation, resulting in small infants and decreased head circumference.

Substance-using women and their infants are endangered by the spread of the human immuno- deficiency virus (HIV). Every medical institution should follow Occupational Safety and Health Administration standards and universal precautions with respect to the blood and body fluids of all patients. To use such precautions only with known HIV-infected persons or known alcohol and other drug abusers places health care workers at great risk and fosters stereotyping. It is essential that HIV positive women are identified during pregnancy so that appropriate antiretroviral treatment can be initiated and hence reduce the rate of mother to child transmission of the virus.

In this time of excessive use and abuse of alcohol, cigarettes, cocaine, and other drugs, it is clear that wider recognition of such abuse -- as well as active intervention efforts - are needed. It is also clear that, in addition to the policies and procedures usually followed prenatally and during labor, delivery, and postpartum, specific attention must be paid to pregnant, substance-using women and their infants.

It is not enough to provide obstetrical care to substance-using women; a holistic approach is essential. This approach should incorporate alcohol and other drug treatment, as well as help for all of the problems of daily living and survival that confront and confound these women.