The effects of prenatal exposure to drugs on brain development are complex and are modulated by the timing, dose, and route of drug exposure. It is difficult to assess these effects in clinical cohorts, which are beset with multiple exposures and difficulties in documenting use patterns. This can lead to misinterpretation of research findings by the general public, the media and policy makers, who may mistakenly assume that the legal or illegal status of a drug correlates with its biological impact on fetal brain development and long-term clinical outcomes. It is important to close the gap between what science tells us about the impact of prenatal drug exposure on the fetus and the mother, and what we do programmatically with regard to at-risk populations.