Pharmacotherapy and behavioral treatment for substance use disorders during pregnancy and postpartum: a narrative review

INTRODUCTION: Substance use disorders (SUDs) are common in pregnancy and the postpartum year (the perinatal period), yet research, guidance, and reimbursement have concentrated on opioid use disorder (OUD).Meanwhile, alcohol, cannabis, tobacco, and stimulant use disorders are similarly prevalent and often co-occur. This review examines medication options for these five SUDs in the perinatal period, together with the behavioral treatments that accompany or preempt them. AREAS COVERED: This narrative review synthesizes literature published from January 2020 to September 2026 (PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov), plus foundational studies, on medications and principal behavioral treatments for tobacco, alcohol, cannabis, opioid, and stimulant use disorders in pregnancy and the first 12 months postpartum. Evidence is graded from pregnancy-specific trials to extrapolation from nonpregnant populations. EXPERT OPINION: The focus on OUD has left alcohol, cannabis, and stimulant use disorders comparatively orphaned in the perinatal period, and emerging medications need pregnancy-specific evaluation rather than extrapolation or blanket avoidance. For any SUD, a shared, dyadic decision-making framework that weighs the risks of untreated illness against those of treatment can guide care.