Drug abuse during pregnancy has attracted national attention, but most studies are from large cities. This study is concerned with the indigent pregnant patients in a midsized city in the southeastern United States. In a 23-month study, 2,442 patients were delivered of neonates. Using specific criteria, 511 patients were tested for drug abuse. A positive test was identified in 156 (31%), cocaine being the most common agent. During 2 months of random testing, 15 patients (16%) had positive drug screens. Comparison of drug-positive pregnant patients with general obstetric patients identified many adverse obstetric and perinatal outcome data. Drug-positive patients weighed less, were older, were prone to not seek prenatal care, and were more likely to deliver prematurely and have a growth-retarded infant. Drug abuse in this population had significant impact on the health of the patient and her unborn infant.