In this episode of True Birth, we take on one of the most fraught subjects in pregnancy care: substance use. Their conversation goes beyond the obvious admonition that “drugs are bad in pregnancy” to explore the nuance — what counts as a teratogen, which substances alter fetal development directly, and which compromise pregnancy through vascular, placental, or behavioral pathways.

The discussion begins with tobacco, a substance that does not cause specific birth defects but exerts powerful vascular effects that restrict blood flow to the placenta, increasing the risks of low birth weight, preterm birth, and ectopic pregnancy. From there, they move to alcohol, one of the few true teratogens, responsible for fetal alcohol syndrome and its enduring neurodevelopmental and behavioral consequences. The conversation then widens to heroin and opioids, which do not deform fetal anatomy but devastate pregnancy outcomes through miscarriage, placental abruption, and neonatal withdrawal syndromes.

Cocaine emerges as a particularly dangerous agent, not for teratogenicity but for its capacity to cause catastrophic circulatory collapse in both mother and fetus — strokes, abruptions, and even loss of fetal limbs due to infarcted placental tissue. The hosts also explore the gray areas: hallucinogens like LSD, stimulants such as ecstasy, and prescription amphetamines. They note the complexity of studying these substances, given the socioeconomic, dietary, and mental health confounders that often accompany their use.

What makes this episode compelling is not just the catalog of risks but the larger question of how to think about exposure. Mallon and Abdelhak acknowledge the historical shifts — from a time when physicians condoned “a few cigarettes a day” to today’s zero-tolerance policies — and they highlight emerging treatments for addiction, such as Ibogaine, which may offer new hope for patients but remain medically and legally unsettled.

The episode’s takeaway is clear: in pregnancy, no recreational substance is benign. Some, like alcohol, directly alter embryologic development; others, like nicotine and cocaine, impair the very systems that sustain pregnancy. The evidence is complex, but the principle is simple — abstaining is the only truly safe choice.

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For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement:

• YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources .
• Instagram: Follow us for daily inspiration and updates at @maternalresources .
• Facebook: Join our community at facebook.com/IntegrativeOB
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Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com .

Two Days, Two Docs: Stories from the Delivery Room takes you inside an unfiltered, behind-the-scenes look at 48 hours in Labor & Delivery through the eyes of two physicians: Dr. Yaakov Abdelhak and Dr. Apig Mosses from Maternal Resources. From the adrenaline of middle-of-the-night emergencies to the quiet, awe-filled moments of new life, these stories capture the highs, lows, and everything in between. Whether you’re a fellow clinician, an expectant parent, or simply curious about what really happens beyond those hospital doors, you’ll hear the human side of medicine—raw, real, and unforgettable.

• YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources .
• Instagram: Follow us for daily inspiration and updates at @maternalresources .
• Facebook: Join our community at facebook.com/IntegrativeOB
• Tiktok: NatureBack Doc on TikTok

Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com .

The American College of Obstetricians and Gynecologists released new clinical guidance on April 17, 2025 that recommends, as they see it, reimagining prenatal care in the U.S. Instead of the traditional 12–14 in‑person visits, ACOG now advocates for individualized prenatal care schedules—especially for average‑ and low‑risk patients—tailored based on medical, social, and structural determinants of health as well as patient preferences The guidance encourages early needs assessments (ideally before 10 weeks), shared decision‑making, coordination of social support resources, telemedicine, and group care modalities to reduce barriers and drive equity Drawing on the PATH framework developed with the University of Michigan, ACOG presents sample visit schedules and monitoring strategies reflecting evidence that fewer visits—with flexible modalities—can maintain quality while improving access and patient experience

As clinicans who have been offering unparalleled care for decades, find out what Dr. Abdelhak and his team at Maternal Resources think of groundbreaking this new update.

• YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources .
• Instagram: Follow us for daily inspiration and updates at @maternalresources .
• Facebook: Join our community at facebook.com/IntegrativeOB
• Tiktok: NatureBack Doc on TikTok

Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com .