A child’s prenatal exposure to maternal substance use during gestation is recognized as one of the most significant barriers to the child’s ultimate healthy development.  The direct biological toxicity of the drugs and the social and psychological disarray of the substance-misusing environment during gestation ultimately impede the child’s growth and development and pose a grave risk to the child’s overall well-being.  This session will address the psychosocial and neurobiological changes that occur in the pregnant woman and her developing fetus as a result of exposure to tobacco, marijuana and illicit drugs and describe maternal and neonatal outcomes in pregnancies complicated by substance misuse.