What you might be experiencing
Substance use during pregnancy creates a situation where fear, guilt, and secrecy tend to compound each other. The pregnant person may be avoiding prenatal care not because they don't care, but because they're afraid of being judged, reported, or separated from their baby. That avoidance delays care at exactly the time when early intervention matters most. As someone who loves them, you may be holding your own fear alongside theirs — afraid to say the wrong thing, afraid of what might happen if you do nothing, and unsure which risk is greater.
The medical picture varies depending on the substance involved, how much is being used, and how far along the pregnancy is. Possible complications include preterm birth, low birth weight, neonatal withdrawal, and longer-term developmental concerns. Stopping certain substances suddenly — particularly alcohol and benzodiazepines — without medical supervision can itself pose serious risks during pregnancy, which means the path forward isn't simply "stop using" but rather "get medical support to stop safely." That distinction matters, and it's worth communicating to your loved one if they're considering quitting on their own.
What can help
When someone you care about is using substances during pregnancy, the most effective thing you can do is approach them with concern for both them and the baby — not with ultimatums or shame. Shame tends to increase secrecy and delay care. Practical offers of help often land better than advice: offering to find providers, attend an appointment, or handle transportation removes some of the barriers that make seeking care feel overwhelming.
Look specifically for integrated programs that combine prenatal care, addiction treatment, housing support, and case management. These programs are designed for exactly this situation and are more effective than either type of care in isolation. If you're not sure where to start, a call to a local hospital's OB or social work department, or a substance use helpline, can point you toward resources in your area. It also helps to understand your state's laws around substance use and pregnancy — reporting practices vary significantly, and knowing what's actually required versus what's feared can help your loved one feel safer seeking care. Many treatment-focused programs actively work to keep families together when it is safe to do so.
When to reach out
Getting your loved one connected to medical care is not a last resort — it's the right move as soon as you know there's a concern. You don't need to wait for a crisis to encourage an evaluation. A provider experienced in high-risk pregnancy can assess the situation without the judgment your loved one may be expecting, and the earlier care begins, the better the outcomes tend to be for everyone involved.
Seek immediate medical attention or call local emergency services if your loved one is showing signs of withdrawal, is at risk of overdose, has had no prenatal care, or is in a situation involving violence or acute safety risk. These are emergencies that require professional response, not watchful waiting.
If you or your loved one is overwhelmed and needs to talk to someone right now, if you're in the US and need immediate support, you can call or text 988 (Suicide & Crisis Lifeline) at any time.