Pregnancy and Substance Use turns stigma-heavy conversations into clear, compassionate, and evidence-based care spanning preconception, antenatal, intrapartum, and the first postpartum year. Start with safety and trust: universal opt-out screening for alcohol, tobacco/nicotine, opioids, stimulants, benzodiazepines, and cannabis embedded in routine visits; plain-language consent; and non-punitive scripts that keep families engaged. Assessment maps sleep, pain, nausea, trauma history, intimate partner violence, housing/food stability, and caregiving load—because stressors drive use as much as pharmacology. Treatment is stepped: brief interventions and motivational interviewing for low-risk patterns; medications for opioid use disorder when indicated (including buprenorphine induction options and continuity through delivery); alcohol care anchored to abstinence goals with psychosocial supports and nutritional safeguards; tobacco treatment framed as routine perinatal health, not a moral test. Stabilize circadian rhythm early—protected dark hours, morning light, planned naps with partner/kin help—so learning and self-control improve. Coordinate tightly with obstetrics, pediatrics, social work, and lactation so plans don’t fall apart at handoffs; create written birth plans that include pain control without destabilizing recovery. After delivery, protect bonding and feeding while guarding maternal sleep; monitor for mood, anxiety, PTSD, and relapse risk with fast access to therapy and peer support. Eligibility and equity matter: interpreters, low-literacy visuals, transport/tele options, and benefits navigation convert “willing” into “able,” especially for young parents and those living far from clinics. If you’re designing programs or scouting models at a perinatal addiction conference, this page provides induction checklists, room-in protocols, non-stigmatizing NAS/NOWS care, and discharge bundles that include naloxone, safer-use education, and warm handoffs. For whole-family supports and collaborative pathways, pair this with Perinatal Mental Health.