BACKGROUND: Pregnant women experience significant barriers to disclosing substance use and accessing treatment services, with serious implications for both maternal and fetal health. Despite the importance of this issue, no literature review has previously synthesised the available evidence. This review brings together current literature on the barriers to disclosure and treatment engagement among pregnant women who use substances.

METHODS: A systematic search was conducted across Ovid Medline, Embase, PsycINFO, Web of Science, Scopus, CENTRAL, PubMed, Google Scholar, ResearchGate, and Academia. Study quality was assessed using the Mixed Methods Appraisal Tool. Data extraction followed a predefined template, and data were analyzed using a narrative synthesis approach.

RESULTS: Nineteen studies were included in the analysis, which identified multiple barriers to prenatal substance use disclosure and treatment across personal, systemic, and financial domains. Barriers to disclosure were stigma, fear of judgment, and distrust of healthcare providers. Barriers to treatment encompassed structural challenges, including fragmented healthcare systems, limited provider knowledge and inconsistency in care, inadequate screening, and a shortage of specialised treatment facilities. Limited childcare facilities and financial constraints further reduced treatment engagement.

CONCLUSIONS: The findings underscore the need for integrated care models that address these barriers and support early interventions to encourage disclosure and treatment uptake. Future research should examine how different groups of women are affected by these challenges to inform more targeted, culturally responsive, and equitable interventions.