Gamma-hydroxybutyrate (ghb) is a controlled substance that is often abused due to its euphoric, sexual and sedative effects. Both acute intoxication with and withdrawal from ghb are potentially lethal, and need to be treated in an in-patient environment. We report the case of a female patient who used ghb regularly during the first trimester of pregnancy. We subsequently describe available evidence on the impact of ghb on fetal development, and how existing guidelines for ghb detoxification differ in pregnant patients.