Background:Opiate use in pregnancy is on the increase. There are a number of complications associated with this problem but current data from UK centres are sparse. Design:A retrospective study. Setting:A North of England Hospital. Methods:Maternal and neonatal case records were studied and a standard data set completed. Main outcome measures:Maternal and neonatal outcomes were classified by the woman’s drug usage at the end of pregnancy. Results:One hundred and ten babies born to 108 women were studied and 41%had evidence of previous exposure to the hepatitis C virus. Women who took heroin in later pregnancy were significantly more likely than women who were stabilised on methadone to have a baby who needed morphine (40%versus 19%),had higher mean maximum neonatal abstinence scores (NAS) (5.8 versus 4.7) and stayed in the neonatal unit significantly longer (mean 17.2 days versus 11.8 days). There were two neonatal deaths and the overall rate of prematurity was 29%. Conclusions:The outcome for pregnancy in women who use opiates is complicated by high rates of prematurity and neonatal death. Women who used heroin in later pregnancy had babies who developed more severe NAS and needed a longer hospital stay than women who used only methadone. There are a number of complications associated with this problem but current data from UK centers are sparse. Design: A retrospective study. Setting: A North of England Hospital. Methods: Maternal and neonatal case records were studied and a standard data set completed. Main outcome measures: Maternal and neonatal outcomes were classified by the woman’s drug usage at the end of pregnancy. Results: One hundred and ten babies born to 108 women were studied and 41% had evidence of previous exposure to the hepatitis C virus. Women who took heroin in later pregnancy were significantly more likely than women who were stabilizing on methadone to have a baby who needed morphine (40% versus 19%), had higher mean maximum neonatal abstinence scores (NAS (5.8 versus 4.7) and stayed in the neonatal unit significantly longer (mean 17.2 days versus 11.8 days). There were two neonatal deaths and the overall rate of prematurity was 29%. Conclusions: The out come for pregnancy in women who op op it is complicated by high rates of prematurity and neonatal death. women who used heroin in later pregnancy had babies who developed more severe NAS and needed a longer hospital stay than women who used only methadone.