Abstract
Perinatal substance exposure is evolving rapidly, often before data on exposure outcomes are available. New exposures to substances include adulterants found in established drug supplies such as fentanyl, xylazine, nitazenes, and medetomidine, and substances promoted as herbal or natural supplements such as kratom and tianeptine. In addition, there are prescription medications being used in new or unintended ways, such as ketamine. This narrative review details some of the most common substances currently emerging in the United States and discusses the potential effects on pregnancy outcomes. It also highlights the importance of comprehensive inquiry into substance exposure and discussion regarding minimizing the risks of exposure in the setting of limited perinatal data.