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Purpose: To support efforts to prevent fetal alcohol syndrome (FAS), population-based data are needed on the prevalence of alcohol use at any time during gestation, particularly among women who were recent and at-risk drinkers.

Methods: We used National Longitudinal Survey of Labor Market Experiences in Youth (NLSY) files to estimate the prevalence of any drinking during pregnancy and to evaluate alcohol history risk factors among 6676 births reported by women with prepregnancy drinking data. Prevalence estimates were obtained for 2-year intervals for all 1982–1995 births and for subsets with prepregnancy recent and at-risk drinking.

Results: Among all births, drinking during pregnancy declined from 38.3% in 1982–1983 to 23.0% in 1994–1995 (p < 0.0001). Drinking during pregnancy also declined over time among recent and at-risk drinkers (p < 0.0001), but the 1994–1995 prevalences were still high (39.3% and 29.0%, respectively). Adjusted logistic models confirmed both the decrease in risk for the later birth years and the persistent heightened risk for births among recent and at-risk drinkers.

Conclusions: In addition to ongoing universal prevention strategies that have helped reduce the prevalence of drinking during pregnancy, selective and indicated prevention approaches are needed to encourage abstinence during pregnancy among recent and at-risk drinkers.