Child and maternal health outcomes following antenatal exposure to classic psychedelic substances: a systematic review.

Importance: As the cultural, scientific, and legal landscape surrounding psychedelics continues to shift toward greater access and acceptability, it is likely that increasing numbers of women of reproductive age may be exposed to these substances. Despite this, the evidence on antenatal exposure has not been systematically reviewed. Objective: To synthesize the human literature on child and maternal outcomes following antenatal exposure to classic psychedelics. Evidence review: A systematic literature search was conducted in Medline, Embase, Web of Science, PsycInfo and CENTRAL for original peer-reviewed studies published from inception to 15 July, 2025, that reported on antenatal exposure to psychedelics. Two independent reviewers conducted title and abstract screening, full text screening, data extraction and risk of bias assessment. The Joanna Briggs Institute (JBI) critical appraisal tools were used for risk of bias assessment. As significant heterogeneity in outcome reporting and study design precluded meta-analysis, the findings were qualitatively synthesized. The protocol was pre-registered on PROSPERO (CRD420251082910). Findings: A total of 42 studies met the inclusion criteria, encompassing 251 women who were exposed to a psychedelic substance during pregnancy or prior to pregnancy from across 9 countries. Almost all studies were conducted in high-income countries (k = 38, 90.5%), of which most were conducted in the US (k = 29, 69.0%). LSD was the most commonly reported psychedelic substance (k = 38, 90.5%), more than half of the articles were case reports (k = 23, 54.8%), and most studies were published prior to the year 2000 (k = 31, 73.8%). In terms of child and maternal outcomes, two articles (4.8%) reported on the outcome of spontaneous abortions, no articles reported on maternal deaths, one (2.4%) on stillbirth, 16 (38.1%) on neonatal mortality, 17 (40.5%) on preterm birth, 15 (35.7%) on birthweight and 26 (61.9%) on congenital malformations. The certainty of evidence for all outcomes was deemed to be very low using the GRADE approach. Conclusions and relevance: The current literature on child and maternal outcomes following antenatal exposure to psychedelics is notably sparse, mainly consisting of case reports or small sample sizes drawn almost entirely from high-income countries. These findings highlight that contemporary, methodologically robust research on psychedelics during pregnancy is urgently needed.