Alcohol use during pregnancy may have increased between 2011 and 2024 in the United States, with national survey data showing higher rates of current alcohol use, binge drinking, and heavy drinking over time.
In a repeated cross-sectional analysis using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, a nationally representative telephone survey of noninstitutionalized adults, investigators assessed 33,729 pregnant women aged 18 to 49 years who reported alcohol use information between 2011 and 2024. For comparison, they examined trends among nonpregnant women of reproductive age. The primary outcome was past-month current alcohol use, while secondary outcomes included binge drinking, heavy drinking, and demographic and behavioral correlates of alcohol use.
Current alcohol use among pregnant women increased from 9% in 2011 to 2012 to 15% in 2023 to 2024, representing a 59% relative increase over the study period. Binge drinking increased from approximately 3% to 5%, while heavy drinking rose from less than 1% to 2%. Analyses across successive 2-year survey periods also showed continued increases in the prevalence of current alcohol use, binge drinking, and heavy drinking over time.
The increase in current alcohol use peaked at 15% from 2021 to 2022 before declining slightly from 2023 to 2024, a pattern the investigators described as possible stabilization rather than reversal. Similar trends were observed for binge drinking and heavy drinking.
Alcohol use was more common among pregnant women who were aged 35 to 49 years, college graduates, employed, or not married or partnered. Behavioral factors also differed across the groups. Current alcohol use was reported by 26% of the pregnant women who used tobacco compared with 11% of those who did not. Likewise, 23% of women reporting frequent mental distress reported current alcohol use compared with 11% of those without frequent mental distress.
Among pregnant women who reported any alcohol use, 68% of those who used tobacco also reported binge or heavy drinking compared with 31% of those who did not use tobacco, suggesting that higher-risk drinking frequently co-occurred with tobacco use. The investigators noted that these findings may help inform prevention efforts targeting behavioral health and polysubstance use.
The study was limited by reliance on self-reported alcohol use, which may underestimate consumption because of stigma and social desirability bias. Estimates for binge and heavy drinking were less precise because of smaller sample sizes, and the survey did not collect detailed information on the timing, duration, or amount of prenatal alcohol exposure. As a repeated cross-sectional analysis, the investigators identified temporal trends but could not determine the reasons underlying the observed increases.
The findings emphasized that no amount of alcohol has been established as safe during pregnancy and that understanding factors associated with higher-risk drinking patterns may help guide prevention strategies.
"From 2011 [to] 2024, the prevalence of current alcohol use, binge drinking, and heavy drinking each increased among pregnant women in the [United States], with possible stabilization in more recent years but no clear reversal of overall upward trends," wrote lead study author Emilie Bruzelius, PhD, of the Department of Epidemiology at the Columbia University Mailman School of Public Health, and colleagues.
Dr. Bruzelius reported receiving nonfinancial support from RAND Corporation, Magee-Women's Research Institute & Foundation, and the College on Problems of Drug Dependence outside the submitted work. The study authors reported no other conflicts of interest.
Source: JAMA
