Drinking during pregnancy has been on the rise, according to a research letter published in JAMA.

In a national survey analysis of nearly 34,000 pregnant women between ages 18 and 49, the use of any alcohol (at least one drink in the past month) increased from 9.1% in 2011-2012 to 14.5% in 2023-2024, the end of the study period. The trend peaked at 15.2% in 2021-2022.

Binge drinking, defined as four or more drinks on one occasion, increased from 2.6% to 4.6% over the study period. Heavy drinking, defined as eight or more drinks per week, increased from 0.8% to 2.0%. Data came from the Behavioral Risk Factor Surveillance System, a CDC-sponsored phone survey.

“Despite being told otherwise, many people have a belief that drinking is not that bad in pregnancy,” said Ana Tobiasz, MD, assistant professor of maternal-fetal medicine at Northwestern Medicine Feinberg School of Medicine in Chicago who was not associated with the study. “They’ll say, ‘Well in Europe they have wine in pregnancy and they’re fine.’”

Compared with nondrinkers, women reporting any alcohol use were more likely to be aged 35-49 years, college graduates, employed, and unmarried.

“More and more research is suggesting that even low-to-moderate alcohol use can pose neonatal risks,” said Emilie Bruzelius, PhD, postdoctoral research fellow in the Department of Epidemiology at the Colombia Population Research Center in New York City and first author of the study. “But we’re most concerned about binge and heavy drinking, and we don’t see the same demographic pattern for these levels of drinking.”

Tobacco use was strongly associated with the highest-risk drinking behaviors, with 68% of tobacco users reporting binge or heavy drinking compared with 31% of nonusers.

About half (51%) of women experiencing frequent mental distress, defined as 14 or more poor mental health days in the month, reported binge or heavy drinking compared to women without frequent mental distress (33%). Poor mental health was also associated with any alcohol use (22.8% vs 11.1%).

Alcohol use during pregnancy has been linked to miscarriage; stillbirth; and cognitive, neurologic, and behavioral deficits in children.

“Not every fetus responds to alcohol the same way, because genetics also plays a role,” Tobiasz said. “If a person has a couple of drinks during pregnancy, one fetus may not be affected whereas another may experience terrible effects.”

The findings are consistent with another national analysis published earlier this year that also reported increases in alcohol use during pregnancy, with approximately 15% of pregnant women reporting alcohol use between 2021 and 2024.

Because drinking in general tends to be heavily underreported, the true prevalence of drinking during pregnancy is likely higher, Bruzelius said. Fear of judgment may discourage patients from disclosing alcohol use.

“We’ve seen time and time again that a stigmatizing attitude makes things worse,” Bruzelius said. “The key is engaging people in treatment and making sure they feel willing and comfortable to disclose their alcohol use so that they can get the help that they need.”

The sources cited in this article do not report any disclosures related to this study.

Brittany Vargas is a journalist covering medicine, mental health, and wellness.