Studies of pregnant ewes indicate that cocaine increases maternal blood pressure and decreases uterine blood flow. A possible consequence of this is fetal hypoxemia (lack of oxygen). Cocaine abuse by pregnant women is also associated with prematurity, low birth weight, and intrauterine growth retardation. Cocaine-exposed infants often display withdrawal symptoms, such as tremulousness, muscular rigidity, rapid breathing, irritability, jitteriness, vigorous sucking, and poor state control. The increase in cocaine use by all women, particular those who are of childbearing age or who are already pregnant, has important implications for the medical profession and drug treatment programs. Health care providers must be able to identify pregnant drug users and advise these patients accordingly. Prevention and intervention strategies can reduce the harmful effects of drug use during pregnancy. Federal, State, and local agencies should fund public education, while enrollment in prenatal care and/or drug treatment programs should be encouraged. Therapeutic family day care centers with programs for drug-abusing women and their children can provide an important environment for parent training. The epidemic use of cocaine by the general population is discussed. An appendix provides an overview of drug use and pregnancy and a form for keeping a daily record of neonatal withdrawal symptoms. 89 references