Despite multiple efforts to reduce the use of illicit drugs, the epidemic of addiction continues to be a significant public health issue. Through its easy availability, the number of people afflicted with this addiction continues to rise, including women of childbearing age. Secondarily, any health care crisis that occurs in this age group of women will have potential implications in pregnancy, infancy, and childhood. The use of cocaine alone or in conjunction with other illicit drugs, combined with the normal physiological cardiovascular changes in pregnancy, leads to a myriad of pathophysiological changes, thereby placing the life of the pregnant cocaine user, as well as the health status of their unborn fetus and neonate at risk for adverse outcomes. As more data are available, the long-term physical, mental, and developmental sequelae for children exposed to cocaine in utero prove that this public health crisis has serious implications. The pregnancy-specific maternal, fetal, and neonatal risks of cocaine use during the antepartum period are reviewed.