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Drug use during pregnancy is associated with adverse prenatal and post-natal consequences. Despite these complications, an alarming number of women are unable to cease drug use once they become pregnant. This population has a number of medical, obstetrical, psychosocial and psychological needs that challenge the skill of providers and the resources available to the treatment community. Novel approaches are needed to effectively treat drug abuse during pregnancy and to prevent postpartum relapse. This article reviews the prevalence of substance use during pregnancy; presents barriers that impede treatment access and retention for pregnant women; and presents a novel behavioral intervention, Reinforcement-Based Treatment (RBT), for initiating abstinence and preventing relapse in this vulnerable population.