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Methamphetamine use is widespread among pregnant and reproductive-aged women in Hawai'i. Women who use methamphetamine require comprehensive care that is gender specific and tailored to their needs. In Hawai'i, more services are needed to solve this serious public health problem. The authors present three cases of methamphetamine use with negative maternal and fetal outcomes. The first case describes a pregnant woman with daily methamphetamine use who experienced cardiac arrest with subsequent preterm delivery and maternal death due to g