In the context of the opioid epidemic and racial inequities in maternal and child health outcomes, there is a growing interest among clinicians, patients, and health policymakers in understanding the impact of punitive state policies on pregnant individuals using drugs on healthcare access and outcomes. This systematic review investigates the types of punitive policies towards pregnant individuals using drugs and their impact on maternal and child health outcomes. Following the PRISMA guidelines, we screened 408 studies, including 26 relevant studies, to examine the prevalence and impact of punitive laws targeting pregnant individuals using drugs. The findings reveal an increase in states implementing punitive policies over the years, such as considering substance use as child abuse, mandated reporting with positive toxicology testing, reporting of opioid exposed infants (including clinician-prescribed opioid therapy), and cannabis-related regulations, including prohibiting breastfeeding when using cannabis. Our results show mixed findings on neonatal abstinence syndrome (NAS) and mandatory reporting outcomes. While some studies suggest an increase or decrease in NAS following punitive policy implementation, some report reduced mandatory reporting may be attributed to heightened stigma perception resulting from the laws, provider distrust of child protective services, and confusion about reporting procedures. Additional consequences of punitive policies include an increase in out-of-state births and a decrease in the receipt of prenatal and postpartum care, deterring pregnant individuals from seeking substance use treatment during pregnancy. Furthermore, the implementation of policies allowing the incarceration of people using substances during pregnancy is associated with an increase in out-of-state births, potentially placing pregnant individuals and infants at greater risk. This study describes the pernicious, if unintended, consequences of punitive policies across states, within hospitals and society. It discusses the implications for intervention, providing examples of theory application in research and practice. Addressing challenges in tailoring deimplementation strategies to specific contexts and suggesting future research directions are included.