Alcohol use during pregnancy increased in the United States from 2011 through 2024

Prenatal alcohol exposure-a contributor to adverse pregnancy outcomes and the leading preventable cause of neurodevelopmental disability worldwide-has increased in the United States over the past decade. The new paper by researchers at Columbia University Mailman School of Public Health is published in JAMA.

While estimates of alcohol use during pregnancy had remained relatively stable since the 1990s, national data had not been updated beyond 2020. The new findings suggest that alcohol use during pregnancy, including higher-risk drinking patterns, increased from 2011 through 2024.

Alcohol consumption in the general population has changed considerably in recent years, particularly during the COVID-19 pandemic, but national estimates of prenatal alcohol use did not extend beyond 2020."

Emilie Bruzelius, PhD, postdoctoral research fellow, Substance Abuse Epidemiology Training Program (SAETP), Department of Epidemiology, Columbia Mailman School

To provide updated national estimates, the researchers analyzed trends in current alcohol use, binge drinking, and heavy drinking among pregnant women in the United States from 2011 through 2024, using data from the Behavioral Risk Factor Surveillance System (BRFSS), a CDC-sponsored telephone survey. The analysis included women ages 18 to 49 who reported being pregnant and provided information on alcohol use. For comparison, the researchers also examined trends among non-pregnant women of reproductive age.

Alcohol use was assessed based on self-reported drinking during the previous month and included any current alcohol use (one or more drinks), binge drinking (four or more drinks on one occasion), and heavy drinking (eight or more drinks per week).

The study included 33,729 pregnant women who provided information on past-month alcohol use. The prevalence of current alcohol use increased from 9 percent in 2011–2012 to a peak of 15 percent in 2021–2022, before declining slightly to 14.5 percent in 2023–2024. Binge drinking and heavy drinking followed similar patterns, reaching 4.6 percent and 2 percent, respectively, by 2023–2024.

"When we adjusted for long-term trends using statistical models, we found that each successive two-year period was associated with higher odds of current alcohol use, binge drinking, and heavy drinking during the past month," Bruzelius said. "These findings indicate statistically significant increases across the study period."

The researchers also found a strong association between tobacco use and higher risk drinking among pregnant women who reported consuming alcohol. Among those who engaged in binge or heavy drinking, 68 percent also reported tobacco use, compared with 31percent of those who did not use tobacco.

Overall, the findings show that the prevalence of current alcohol use, binge drinking, and heavy drinking increased among pregnant women in the United States between 2011 and 2024. Although the trends may have stabilized in the most recent years of the study, the data do not indicate a clear reversal of the long-term increase.

"While no amount of alcohol has been established as safe during pregnancy, these increases across all patterns of drinking are concerning," said Silvia Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School and the study's senior author.

Co-author Gretchen Bandoli, PhD, is in the Department of Pediatrics at the University of California San Diego. 

This study was funded by NIH-NIDA T32DA031099.