Prior to establishing a specialist service in Newcastle upon Tyne, no local data existed on the extent of substance use during pregnancy. From February 2002, a consultant obstetrician co-ordinated a multidisciplinary team within an antenatal clinic setting, and accepted all women with a current or previous history of substance use (including alcohol). Open access was achieved, with input from the drug and alcohol liaison midwife, sexual health and mental health trained midwives and psychiatric and social services if appropriate. There were 83 referrals in the first 6 months (3.7% of the 6-month booking population of 2250). Age range 17-39 years, 87% were single (background population 40%) and 40% primiparous. Seventy-eight per cent lived within two of 15 postcode areas. Heroin was the drug of choice (n = 34) followed by alcohol (n = 12) and benzodiazepines (n = 7). Mean booking gestation for opiate users: previous use 15 weeks (n = 5), opiate treatment programme 18 weeks (n = 27) and no opiate treatment 28 weeks (n = 7). There was one IUD and of 23 infants delivered to date, six required special care admission. Of the 23 intravenous users, five were hepatitis C positive.