The clinical and animal literature describing the effects of cocaine use during pregnancy is reviewed. The difficulties associated with studying populations using illicit drugs during pregnancy and the multiple risk factors present in cocaine-using pregnant women limit the strength of the drug-associated effects. Nevertheless, cocaine use during pregnancy is associated with a significant number of obstetrical complications, small for gestational age infants and neurobehavioral abnormalities. In animal studies, only the neurobehavioral abnormalities could be demonstrated following the administration of non-toxic doses of cocaine. Furthermore, animal studies indicate that neurochemical changes, including those identified in the neuroendocrine axis, persist into adulthood.