Some children are taken from their parents almost as soon as they are born
It has emerged that across the area there are 96 infants who have been flagged up as a concern to social workers while in the womb.
The revelation has shocked health chiefs and politicians, but charities have emphasised that being on the register gives vulnerable infants the best chance in life.
Children across the Lothians who are on the council registers are deemed to be at "significant risk" of harm once born, including the possibility of being exposed to drug abuse, sexual abuse, physical harm or emotional conflict.
In some cases the baby will be taken straight from the mother after birth, but it is understood social workers' preference is to work with families to reach a more amicable solution.
The city's children and families leader, Councillor Marilyne MacLaren, said: "In Edinburgh we have seen the figures stabilise over the years.
"Early intervention in these cases is absolutely key and we have measures in place to identify mothers and families who have problems. In some cases we need to give parental assistance, in others the baby has to be taken into care.
"The child is the absolute priority. We have to be hard-nosed and it's no use being sentimental about it. When you have a baby born to mum who is an addict, the baby is very ill, not sleeping or feeding and in great discomfort.
"A great deal of hard work goes into the whole system to make sure it works."
There are currently 62 pregnant women in Edinburgh whose unborn baby is on the register.
In West Lothian that figure is 19, 11 in Midlothian and four in East Lothian.
The total rise in the Lothians is notable, from 64 in 2006 to a present total of 96. In total, 509 youngsters not yet born have found themselves on the register in that five-year timeframe.
Social work concerns over physical harm or neglect make up the majority of cases.
NHS Lothian and the four local authorities have worked hard over the years to boost links, meaning midwives and nurses can spot potential problems and alert social work departments instantly. It is thought that parents with alcohol and particularly drug problems form the vast majority of cases.
One social work source told the Evening News: "Often it can be a case of taking the baby straight from birth, which sounds difficult and it is, but it really is the only solution for the sake of the child."
But Cllr MacLaren added: "It can be the case that the baby is the catalyst for a mother to change her life, but it can take an awful lot of time and effort to get to that point."
Alison Todd, director of policy, practice and development, at charity Children 1st, said: "While it is always concerning to hear of cases where an unborn baby is at risk, it is encouraging to know these situations are being monitored.
"Identifying unborn babies at risk means the appropriate services can intervene at the correct stage.
"It may be that with the correct support the baby may be able to remain with the mother following birth as long as it is in the best interests of the child."