Prenatal substance exposure in a digital information ecosystem: a narrative review of clinical, public health, and communication perspectives.

Prenatal substance exposure remains a persistent and evolving public health challenge, shaped by rising polysubstance use, increasing overdose risk during pregnancy and the postpartum period, and longstanding social and structural inequities. Concurrently, pregnant individuals are increasingly exposed to pregnancy‑related health information through social media and other digital platforms, where peer support, reassurance‑seeking, and misinformation coexist. This narrative review synthesizes interdisciplinary evidence spanning epidemiology, developmental science, clinical guidance, public health policy, child welfare, and digital health communication to examine how prenatal substance exposure is identified, understood, and addressed across clinical, community, and online contexts. This review summarizes patterns of substance use during pregnancy, including the prevalence and complexity of polysubstance exposure; reviews established and emerging risks to infants and children; and examines the growing role of digital platforms as both risk and opportunity, highlighting how online misinformation may influence risk perception, stigma, and care engagement, while also offering channels for dissemination of accurate, supportive health messaging. Across domains, the literature reveals important gaps, including limited integration of digital exposure data with clinical outcomes and inconsistent implementation of non‑stigmatizing, consent‑based care practices. Taken together, findings underscore the need for coordinated, equity‑focused strategies that align clinical practice with digital health communication, engage families and communities in content creation and dissemination, and advance longitudinal, interdisciplinary research to support ethical and effective responses to prenatal substance exposure.