AbstractWhile there has been a substantial increase in recreational use of cocaine by young adults, conclusive evidence for cocaine teratogenicity in humans in lacking, and even those believing the drug is teratogenic agree that the rates are quite small. While counseling pregnant women on their teratogenic risk, it was our impression that there is an unrealistically high perception of reproductive risk of cocaine. We wished to quantify the perception of teratogenic risk of cocaine by the public, physicians, and by pregnant women who were counseled following gestational exposure to the drug. Women taking cocaine during the first trimester of pregnancy (n = 54), controls with post secondary education (n = 30), and physicians (n = 30) were asked, using a visual analogue scale, to quantify the teratogenic risk of cocaine and the tendency to terminate/contiue the pregnancy after first trimester exposure; in the case of the “public” and physicians this was a hypothetical question. Both physicians and the controls perceived cocaine to be teratogenic (13.4 ± 11% risk of major malformations by physicians, and 56.5 ± 22.8% by the “public”). The controls believed cocaine to be as hazardous as thalidomide (57.2 ± 25.6% risk for thalidomide). Asked whether they would wish to terminate such pregnancy in their family, most physicians (56%) and the controls (70%) had a greater than 50% tendency to terminate. In pregnant patients attending Motherisk, the counseling process resulted in a significant decrease in risk perception of cocaine (from 37.5 ± 20.5% to 17.6 ± 14.2%P<0.0005), and a similar decrease in tendency to terminate pregnancy [from 21/54 (38%) with 50% tendency to terminate to 11 (20%);P= 0.0014]. Postnatal follow‐up revealed that eight women terminated pregnancy while the rest had morphologically and developmentally normal babies. An unrealistically high perception of teratogenic risk of cocaine exists among the controls, physicians, and pregnant women. Physicians' erroneous perception may lead them to offer women unjustified terminations of pregnancy after first trimester exposure to cocaine. Counseling these women during the first trimester is effective in preventing termination of many otherwise wanted pregnancies. © 1992