Since the 1970s alcohol and drug use by pregnant women has become a target of intensifying political, professional and personal concern. The present study focuses on prenatal substance use and the regulation of risks by examining different kinds of societal responses to prenatal alcohol and drug use. The study analyses face-to-face encounters between maternity care professionals and service users, medical and political discourses on prevention of alcohol-related foetal damage and the changes in official recommendations on alcohol intake during pregnancy. Moreover, the women’s perspective is addressed by asking how women who have used illicit drugs during pregnancy perceive and rank the dangers linked to drug use.