1 in 8 women drink during pregnancy. Experts dread the consequences

STAT News – Tuesday, May 19, 2026
By Isabella Cueto

The idea of drinking during pregnancy sounds like a generational punchline: Someone’s grandmother drank beer to fatten her fetus, another had a nightly martini to get a healthy amount of sleep — presumably unthinkable behavior in today’s America.

Yet after precipitous declines in the last 50 years, rates of alcohol use in pregnancy in the U.S. started climbing upward a decade ago. More than 1 in 8 pregnant adults reported drinking in the past month, according to STAT’s analysis of 2024 government data, making alcohol use a more common national phenomenon than gestational diabetes. Of those who drank, a quarter reported having four or more drinks in one sitting — binge drinking — in the prior month.

While rates of alcohol use in pregnancy are lower in the U.S. than those of several peer nations, the effects are all around Americans. Alcohol is the key driver of what are, by some estimates, the nation’s top neurodevelopmental conditions: fetal alcohol spectrum disorders, or FASDs.

The exact prevalence of FASDs is difficult to measure, but the most recent federally funded community studies have found as many as 1 in 20 school-aged children may have a disorder caused by prenatal alcohol exposure. By comparison, about 1 in 31 American children has autism, per recent estimates from the Centers for Disease Control and Prevention.

Not all fetuses exposed to alcohol have birth defects or go on to develop intellectual disabilities, researchers say. But every person born with an FASD was harmed by alcohol specifically. They worry this point is being glossed over as Americans question the conventional medical advice of avoiding all alcohol while pregnant.

“There’s been a pushback for almost a decade now, it feels like, of young women just going, ‘Eh, phooey,’” Susan Astley Hemingway, an FASD epidemiologist at the University of Washington, told STAT.

Most people who drink during pregnancy do not have an alcohol use disorder. Only about 6% of pregnant women meet the criteria, per federal survey data. Many others just continue their regular drinking patterns, or dabble in alcohol.

At a time when federal health officials are expressing alarm on issues such as infertility, neurodevelopmental disorders, and drug addiction, they have placed little emphasis on the potential harms of drinking during pregnancy. The Trump administration has instead hampered key data collection efforts that track the nation’s alcohol use, including during pregnancy and in the postpartum period.

Alcohol is extremely dangerous for a developing fetus. Everything from memory and attention span to facial features and height can be affected by exposure to alcohol in the womb, experts told STAT. Some research has found disproportionately high rates of prenatal alcohol exposure among children in the foster care system and adults in prisons, highlighting the deleterious and costly long-term impacts. Still, many people with FASDs go unidentified or are misdiagnosed with other conditions.

Despite the entirely preventable risks of alcohol, a debate has swirled for over a decade about whether light-to-moderate drinking is actually fine during pregnancy. Some parents are even getting such advice from their health care providers, pediatricians told STAT.

“I’ve heard it from the families who are like, ‘Wait a minute, you’re telling me that it was not OK?’” Adiaha Spinks-Franklin, a developmental-behavioral pediatrician based in Texas, said. Parents have been stunned to hear they might have caused FASD problems in their children by following another clinician’s advice, she said. No amount of alcohol has been deemed safe.

Nevertheless, among pregnant women, rates of heavy and binge drinking increased by over 8% every year between 2012 and 2019, a JAMA Network Open study found. The Covid-19 pandemic further fueled the problem.

STAT conducted original analyses of raw data from the CDC’s Behavioral Risk Factor Surveillance System, including responses from over 900,000 American women between 2011 and 2024. Our review shows for the first time that heavy and binge drinking among pregnant women stayed at pandemic-levels through 2023, followed by a dip in 2024, the most recent year for which data are available.

Among women who drank during pregnancy, binge drinking dropped to 25% in 2024 from 43% in 2020, but it’s too soon to say whether the decline has persisted. The CDC has yet to release its own report on the data.

Overall drinking among pregnant women rose slightly over the last decade and edged back in 2024 to about 12.5% of women reporting past-month alcohol use, per STAT’s analysis.

Overall, drinking among pregnant women has remained about the same, with 12.5% of women reporting past-month alcohol use in 2024, per STAT’s analysis.

Public health researchers and pediatricians say the risks to families could mount if more people abandon the decades-old guidance of avoiding alcohol during pregnancy. Many told STAT the U.S. is already letting women with addiction and children with FASDs fall through the cracks.

Risks in early pregnancy

It has been over a half-century since researchers came to the conclusion that alcohol, America’s favorite drug, causes birth defects. Federal health officials and top medical societies moved to action, issuing in 1977 the first public health advisory on the subject, which told pregnant women to cut back to two drinks per day. By 1981, the government had adjusted its position, telling pregnant women to avoid alcohol entirely.

The news would take years to go truly mainstream. Labels warning about the risk of birth defects weren’t added to containers of alcohol until 1989. Many women who came of age during these years, like University of Washington researcher Hemingway, were oblivious to the risks.

“I don’t even hear about it until I’ve graduated, I’ve got a Ph.D., and I’m looking for a job” in the early 1990s, she said. The CDC was tasked with raising awareness about FASDs, and so funded a clinic in Washington state.

Hemingway joined as an epidemiologist. Pretty quickly, she realized there was no clear system being used to diagnose children. A lot of the process was informal, based on a vague assortment of facial features (a know-it-when-you-see-it mentality), she said. Hemingway decided to try to standardize the criteria.

What she and other researchers found was a set of subtle facial features that were specific to fetal alcohol syndrome, or FAS, a more specific diagnosis under the umbrella of FASDs. Children exposed to enough alcohol in utero often had a thin upper lip, small eyes and a smooth philtrum — the area between the upper lip and nose. These features develop around day 19.

“Most women don’t even know they’re pregnant, much less the facial features of the fetus are all coming together,” Hemingway said.

Children with FAS, like others on the spectrum of alcohol-exposure disorders, experience varying degrees of brain damage and growth problems, such as short stature or low birth weight.

While the full range of alcohol-related harms is difficult to measure across populations — some important FASD symptoms, such as behavioral problems or poor coordination, don’t become apparent until years later — biology has offered clear mechanisms of damage.

In the first eight weeks of pregnancy, beginnings are unfolding: rudimentary digestive, respiratory, nervous, and cardiovascular systems form. As a classic teratogen, alcohol interferes with the development of the placenta, and cell division and differentiation. Nerve cells may struggle to multiply and take on their specialized functions. Nutrient exchange between mother and fetus might be hampered. Heart and kidney cells can fail to properly form if exposed to too much alcohol.

Later in pregnancy, alcohol can stunt the growth of the fetal head and body, and interfere with a critical period of brain development in the third trimester. Drinking during pregnancy has also been associated with an increased risk of miscarriage and stillbirth.

That wide range of harms is known. What’s unknown is just how much alcohol can cause them. That is why doctors and scientists say no amount or type of alcohol is fine for drinking. (The zero-risk approach, which some consider draconian, would be for anyone capable of getting pregnant to avoid drinking, as the CDC has advised since 2016.)

Over 5 million adult women report drinking heavily, per 2024 survey data. That reality rubs against another: More than 40% of pregnancies in the U.S. are unplanned, and roughly a third of women find out they are pregnant after the five-week mark.

Rates of prenatal care in the first trimester have also dropped: A quarter of people didn’t receive care until after 13 weeks of pregnancy, according to national data from 2024. Even if a large share of parents quit drinking once they know they are pregnant, it may be too late for some of their babies.

“By that time, what alcohol has done is disrupt the foundation of all of the organ systems,” pediatrician Spinks-Franklin said.

Still, experts stressed that it’s never too late to quit drinking during pregnancy, since additional harms can be mitigated or averted entirely.

Attention and data gaps

The hazards of alcohol use during pregnancy have been frequently pushed aside by other pressing matters, such as the crack cocaine epidemic of the 1980s and, more recently, the opioid crisis.

While undoubtedly harmful substances, opioids and illicit drugs do not cause nearly the number of deaths in the U.S. that alcohol does. Some experts also argue opioids, cannabis, and other common drugs are not nearly as damaging as alcohol is to a developing fetus.

Nevertheless, medical professionals tend to overlook drinking until an obvious problem arises. While about 80% of pregnant women in the U.S. reported being screened for alcohol use, only 16% who said they drank in the previous month received advice to stop drinking or cut back on alcohol, according to a 2023 CDC analysis.

A 2019 survey of over 500 midwives, nurses, and nurse practitioners in the U.S. found only one-third of them screened pregnant patients for alcohol use, and very few used validated tools to do so. Nearly 40% of respondents — trained medical professionals — believed alcohol was safe to use during at least one trimester.

“There was very little attention to alcohol before. And if anything, there might be less,” said Mishka Terplan, a physician-researcher at the nonprofit Friends Research Institute in Baltimore.

The neglect of women’s addictions starts long before pregnancy, as they encounter lower rates of screening for unhealthy alcohol use, and have a lower likelihood of being referred to treatment than men. At the same time, shifting cultural norms and aggressive marketing by the alcohol industry have flooded women with messaging that drinking is a sign of empowered adulthood, gender equality, and personal freedom.

On the whole, men still drink more than women. However, data show women’s drinking has increased more steeply than men’s in recent decades, reaching a zenith during 2020 and remaining high for years afterward. Surges in alcohol-associated liver disease, liver transplant, and death have been the result, stunning doctors and researchers.

It’s still to be seen how heavier drinking by non-pregnant women in recent years will translate to more drinking during pregnancy, and greater effects on their children’s health. Research in other countries has found pre-conception drinking behaviors tend to be a strong predictor of alcohol use during pregnancy. In some European countries, such as Ireland, drinking is ubiquitous before and during pregnancy; so are FASDs.

The U.S. may be caught on its back foot. Data systems used to track changes in drinking behaviors have become less reliable over the past year. Cuts by the Trump administration threaten their future.

Most notably, the fate of the Pregnancy Risk Assessment Monitoring System is in limbo. PRAMS, as it is called, has been the backbone of maternal health surveillance for decades. Several researchers told STAT they have not received any updates on when the latest data, from 2023, would become available. As of late May, the PRAMS website was topped by an alert that new requests for data were not being processed.

The Department of Health and Human Services, which oversees the system, “remains committed to improving maternal and infant health outcomes and will share PRAMS data at a later date,” spokesperson Emily Hilliard said in an email.

The yet-to-be-released data include several new measures of alcohol use in pregnancy and the postpartum period, when many women with substance use disorders are at high risk of relapse.

“How are we supposed to know if our prevention efforts are working, if you can’t watch whether or not the drinking is going up?” Hemingway said.

Her research showed Washington state was able to reduce the prevalence of children born with FASDs. It is one of the only states where lawmakers have dedicated a permanent funding stream for FASD identification and prevention. There is no national registry of the disorders, and only a small amount of research funding devoted to the issue.

The diagnostic tangle

Landon French, 21, spent his whole childhood trying to figure out what was causing him so much trouble. His lack of focus, poor memory, and unusually quick way of processing emotions got him labeled as having ADHD, or maybe autism.

He recalls third grade being particularly challenging because of his behavioral issues — too energetic, not enough attention, and the occasional acting like a cat in class. “I wasn’t very aware of my surroundings or how people act and think,” he said. “I would just do whatever I thought I found interesting.”

French, who was adopted as a baby alongside his siblings, was given many tests to try and figure out his strain of neurodivergence. He was shuffled between nearly a dozen behavioral treatment programs, foster homes, or other transitional housing centers.

It is only in the last few years that he was formally diagnosed with an FASD. At least one sibling was, too. French has since been trying to taper down the ineffective medications he’s been prescribed for ADHD and other conditions he doesn’t have. He is studying graphic design at Ivy Tech Community College in Indiana and lives independently with one sibling. A company helps them manage daily tasks like taking medication and preparing meals.

He and his family have also become advocates with the national nonprofit FASD United, and want more people to know about FASDs and their associated challenges — including interactions with the state.

“The foster care system needs to be rewritten,” French told STAT. “They really, really mishandle people with disabilities, even autism, people with ADHD.”

Children with FASDs are overrepresented in the foster care system, data suggest. In some cases, a child is separated from a parent because of abuse or neglect involving substance use. Kids and young adults with FASDs may also exhibit behavioral problems that create conflict with family members, school officials, or law enforcement. Since the prevalence of FASDs is under-recognized, and foster kids in particular don’t have readily available medical histories, kids may be misunderstood and go without adequate support.

Even pediatricians miss the signs. There is no single accepted diagnostic tool for FASDs, and no easy biomarker. Vincent Smith, associate director of the neonatal intensive care unit at Beth Israel Deaconess Medical Center, said he was not trained on FASDs — the opioid crisis was a much bigger focus at the time — and was shocked to learn how prevalent they are.

“How can something be so common and nobody’s talking about it? It blew my mind,” he told STAT.

The question of ‘light drinking’

Prominent contrarian voices take up a large share of the conversation about alcohol and pregnancy. The economist Emily Oster is a leading voice. Since 2013, when she published her popular book, “Expecting Better,” Oster has asserted there is scant evidence showing low levels of alcohol use are harmful. She argues, against federal guidelines, that up to one serving of alcohol per day in the third trimester is probably low risk, based on the available scientific literature.

She — like others with a similar perspective — doesn’t dispute the hazards of heavy drinking. Oster, who is a Brown University professor, instead interprets a lack of clear science on low-to-moderate alcohol use as permission for women to engage in some drinking.

A dozen years on, her opinion reverberates in online forums for expectant parents, where commenters pick apart Oster’s claims and evidence. Professional medical societies and patient advocacy groups have come out against her view, some calling it irresponsible. Oster has responded to their critiques, and maintained her position.

“My goal in my writing is to provide access to the best data to allow pregnant people and parents to make their own evidence-informed decisions. My work on alcohol in pregnancy follows this model,” she said in a statement to STAT.

“My work is clear on the dangers of heavy and binge drinking during pregnancy, and primarily focuses on understanding the literature on occasional and light drinking.”

Oster is correct that a causal link — proving A causes B — has not been found between moderate alcohol use and negative health outcomes like low birth weight. Some research has found no link at all. However, other studies have found an association between even occasional prenatal alcohol use and long-term negative health effects in children who were exposed.

Researchers and clinicians STAT spoke with take the mixed evidence to mean something different than Oster does. They emphasize that alcohol has not been proven safe during pregnancy, so guidelines must reflect that fact.

Some worry that Oster and her allies are, in the absence of scientific clarity, fostering a culture in which drinking during pregnancy is normalized. Research has found social norms strongly influence our decisions on divisive health issues, including prenatal drinking.

“That person is LYING to pregnant people,” Spinks-Franklin, the developmental pediatrics specialist, said in response to a recent post on Oster’s website, ParentData. Among the key takeaways is that drinking slowly helps “metabolize much of the alcohol” before it gets to a fetus.

Alcohol metabolism, or the speed at which the body breaks down ethanol, can vary greatly from person to person. However, research suggests alcohol quickly crosses the placenta, and that fetuses have few enzymes to process ethanol on their own, so they remain exposed for longer.

While heavy or binge drinking are the strongest predictors of negative outcomes, there is no way for individuals to know how their fetus might be affected by lower amounts of ethanol, researchers told STAT. A 2019 study Hemingway conducted on siblings and twins found fetuses with nearly identical exposure to alcohol could have very different FASD outcomes.

Hemingway said she has assessed children with FASDs whose mothers reported drinking small amounts. She told Oster as much directly in 2013, when she called the economist to vent her frustration, and followed up with a public rebuttal. (Oster has, in turn, taken issue with some of Hemingway’s research methodology.)

Others, like developmental psychologist Lauren Micalizzi, see Oster as a valuable resource for parents overwhelmed by decision fatigue and conflicting evidence. She fits the profile of Oster’s core audience: young, college-educated, professional.

“Emily Oster is incredible, and I read every one of her books,” said Micalizzi, who studies substance use during pregnancy as an assistant professor at Brown University. (Micalizzi said she has no connection to Oster, who she only met in passing at a museum.)

When it comes to alcohol, the economist lays out “some really compelling arguments” for low levels of use carrying few risks, Micalizzi said. However, a lack of clear data showing harm is not necessarily a reflection of safety, and factors such as genetics, social support, and overall health must be taken into account, she said.

After all, alcohol is known to cause health issues in the non-pregnant population, and some animal models have found problems in offspring exposed to small amounts of alcohol. “We can’t simply dismiss that because human observational studies are inconclusive,” she said.

The lack of rigorous scientific data on pregnant populations is a barrier across the board.

Take, for example, the stigma against addiction medications like naltrexone or acamprosate, which can be extremely useful for curbing cravings in alcohol use disorder. Clinicians tend to avoid them out of fear of harming the fetus, survey data suggest. Pregnant women are excluded from clinical trials — they are considered a “vulnerable group” akin to children and prisoners — so there is little safety data to go off of.

Many researchers question whether that paradigm, ostensibly designed to protect women and babies, is actually hurting them. After all, alcohol is a known teratogen; naltrexone is not.

“Summarily excluding pregnant women, without a reason or a plan to address their needs in a timely fashion, does not meet the requirements of ethical research,” Terplan, the obstetrics and addiction medicine specialist, wrote in a recent commentary in JAMA Internal Medicine.

Danielle’s story

Studies have shown pregnancy can be a powerful motivator for people to claw their way out of addiction. For example, over half of women who smoke cigarettes — a famously hard habit to kick — stop during pregnancy. (By comparison, less than 10% of adult smokers are able to.)

Pregnancy had that transformative effect on 29-year-old Danielle Campbell, whose drinking began a decade ago.

She was heartsick, fresh off a breakup and the death of her beloved grandfather. The night of his funeral, Campbell took comfort in a glass of wine at her friend’s house. It made her feel less sad, like she could cope. From then on, Campbell began drinking every day, including at her jobs as a bartender.

When the Covid pandemic began, she moved from her native Birmingham, Ala., down to the coast, Orange Beach. “Drinking down there is really a sport,” she said.

Campbell, then in her mid-20s, soon became so dependent on alcohol she couldn’t wake up and function without having a drink. She fell in love and got married to a man she’d later discover had liver cirrhosis from alcohol. He died of it, unable to stay sober long enough to qualify for a liver transplant.

Campbell’s grief accelerated her drinking. She recalls pouring vodka into a water bottle to take to work, a habit that ultimately cost her a well-paying bartending gig, and that made her realize she had a problem. Addiction wasn’t a far-flung possibility — her father was absent her whole life because of his alcohol addiction, Campbell told STAT. Still, her options for getting out of the cycle were limited. She couldn’t afford both treatment and rent.

Instead, Campbell tried and failed to stop drinking on her own. On Sundays, she’d kneel before the altar at her Pentecostal church. “Please, take this away. I don’t want to drink anymore,” she’d pray.

Her intervention came in the form of a positive pregnancy test one day in late summer of 2024. Campbell had been seeing a new co-worker, her now-husband, Jerome. The change was “instant,” she said — drinking stopped consuming her thoughts that very moment. She also quit smoking, stopped bartending, and moved back to the Birmingham area.

“I couldn’t do it. I had to protect this thing growing inside of me,” she said. Even after the birth of her son, Ezra, Campbell said she had no desire to drink.

Ezra, now a plump toddler, celebrated his first birthday on a warm Sunday in late April.

Alcohol use during pregnancy data analysis methodology

Annual Behavioral Risk Factor Surveillance System (BRFSS) data files from 2011 through 2024 were analyzed incorporating complex BRFSS survey design to produce nationally representative estimates. Survey designs were constructed using the primary sampling unit variable, the stratum variable, and the final raking weight. Age- and race/ethnicity-adjusted prevalence estimates were computed using survey-weighted logistic regression.

The analytic sample was restricted to female respondents aged 18–44 years who reported their current pregnancy status (n=897,907). Respondents who did not answer or refused the pregnancy status, age, or race/ethnicity questions were excluded.

Four alcohol use outcomes were examined:

Any alcohol use, defined as at least one drink of any alcoholic beverage in the past 30 days. Heavy drinking, defined as more than 7 drinks per week, consistent with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) threshold for women. Average weekly drinks were computed by multiplying the reported number of drinking days per week by the average number of drinks consumed per drinking day.

Binge drinking, defined as having 4 or more drinks on at least one occasion in the past 30 days. Respondents who answered “don’t know,” “never,” or “refused” were classified as non-binge drinkers.

Binge drinking among pregnant drinkers, the conditional prevalence of binge drinking restricted to pregnant women who reported any alcohol use in the past 30 days.

All analyses were conducted in R version 4.5.1 (R Foundation for Statistical Computing) using the tidyverse, haven, survey, srvyr, and marginaleffects packages.

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