Over 400,000 babies may be born annually following intrauterine exposure to opiates, stimulants and other illicit drugs. In addition, fetal exposure to alcohol and nicotine is common: of the 56 million women in the childbearing age range, 34 million are drinkers and 18 million are smokers. Published epidemiologic data suggest a strong association between Sudden Infant Death Syndrome (SIDS) and maternal smoking, a weaker association between SIDS and maternal opiate use, a still weaker association between SIDS and maternal cocaine use, and no association of SIDS and maternal alcohol use. Direct scientific links, however, between SIDS and exposure to any of these substances are still lacking. Because of reports in the medical literature and lay press linking maternal substance use to subsequent SIDS, specific drug-related counseling issues must be recognized by health professionals to provide effective intervention in the event of a SIDS death.