Aim and background: Drug abuse is a complex phenomenon, which has various social, cultural, biological, geographical, historical, and economic aspects. According to the WHO, substance abuse is persistent or sporadic drug use, inconsistent with or unrelated to acceptable medical practice. Strategies to improve the management of patients presenting with substance abuse in pregnancy at a multidisciplinary level. The four cases of substance abuse in pregnancy will be presented and their antenatal, intrapartum, and postnatal outcomes will be discussed. Case description: There were two cases of heroin abuse, one case with both heroin and smoking abuse, and one case of cocaine abuse. Out of four cases, one case presented with labor psychosis, later diagnosed as withdrawal symptoms of drug abuse. The second and third cases were antenatal patients both with fetal growth restriction; one of them was lost to follow-up antenatally, and the other one delivered and absconded postnatally. The fourth case was a prisoner with hepatitis C-positive status, and she underwent medical termination of pregnancy. Conclusion and clinical significance: The world statistics demonstrate a grim picture of the existing drug abuse scenario presenting only the tip of the iceberg to the analyst. Therefore, uncovering this growing epidemic by screening at the primary level will allow the detection of cases and timely management for better disease control. The multidisciplinary approach involves extensive obstetric care at the initial prenatal visit (by engaging women in short conversations, providing feedback, and social advice) and timely referral to treatment centers for deaddiction centers for better maternal and neonatal outcomes.