If you’re pregnant, don’t drink any alcohol. Avoiding alcohol during pregnancy is a core message from the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG). No amount, timing, or type of alcohol is safe in pregnancy, and abstinence is always best.

Cannabis use during pregnancy is also risky. However, for pregnant women with opioid use disorder (OUD), the CDC and National Institute for Drug Abuse (NIDA) recommend medication with methadone or buprenorphine and therapy. Medication for opioid use disorder (MOUD) leads to better outcomes for mother and baby. Starting MOUD early in pregnancy is crucial.

Despite clear admonitions to avoid alcohol in pregnancy, U.S. surveillance data from large national surveys consistently demonstrate that alcohol use during pregnancy is common. CDC analyses of the National S urvey on Drug Use and Health (NSDUH) and related data show that 13% to14% of pregnant women had current alcohol use (during the past 30 days), and about 5% reported binge drinking. The figures represent hundreds of thousands of pregnancies annually with alcohol exposure.

Of those engaged in current drinking, 17.8% didn’t have a current health care provider. The women may not have realized until recently that they were pregnant, since many pregnancies are unplanned. The researchers also found that 27.4% of current drinkers who were pregnant suffered frequent mental stress.

Alcohol quickly crosses the placenta, but the fetus has limited capacity to metabolize it, resulting in prolonged exposure during critical periods of growth and brain development. The fetal central nervous system is particularly vulnerable to alcohol. Neurodevelopmental harm may occur even in the absence of facial or growth abnormalities in the newborn.

Alcohol causes a spectrum of lifelong conditions collectively referred to as fetal alcohol spectrum disorders (FASD). They include growth restriction, characteristic craniofacial features, structural anomalies, and—most consistently—neurodevelopmental impairment affecting cognition, executive function, attention, behavior, and adaptive functioning. Many affected individuals don’t exhibit classic facial features, contributing to under-recognition of the disorder. FASD is entirely preventable by the avoidance of alcohol during pregnancy.

Higher levels of exposure, particularly binge drinking, are associated with increased risks of miscarriage, stillbirth, preterm birth, and other adverse outcomes. Vulnerability is modified by genetic factors, nutrition, and co-exposures to other substances.

The CDC and ACOG emphasize universal, nonjudgmental prenatal screening and brief intervention as part of routine prenatal care. Any alcohol use during pregnancy is classified as excessive. Because exposure is frequently under-reported—particularly early in pregnancy due to stigma or delayed pregnancy recognition—clinicians focus on prevention.

Cannabis in Pregnancy

Alcohol use during pregnancy is roughly twice as common as cannabis use. On a........

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