This study was conducted to examine the relationship between prenatal exposure to drugs and parenting stress and child maltreatment. The sample was comprised of 48 subjects including 24 drug-exposed children and a comparison group of 24 non-drug-exposed children matched on age, race, gender and socioeconomic status. The subjects' age ranged from 1 to 33 months with a mean of 13 months. As predicted, mothers who used drugs during pregnancy reported higher levels of stress than foster mothers and comparison mothers on total parenting stress, child related stress, and parent related stress as measured by the Parenting Stress Index (Abidin, 1990). Biological mothers and foster mothers of drug-exposed infants scored higher than comparisons on child-related stress, most notably in the areas of hyperactivity, distractability and adaptability. A strong association was found between maternal use of drugs and child maltreatment serious enough to necessitate removal of the children by CPS. Over 40% of the drug-exposed children were in foster care, most often with maternal grandmothers. Most mothers who used drugs during pregnancy were polysubstance abusers and 21% were intravenous drug users increasing the risk of HIV infection for mothers and children. Implications for intervention are discussed.