Doctors didn’t officially warn against drinking during pregnancy until 1981, when the U.S. Surgeon General issued the first advisory telling pregnant women not to drink at all. But the story of how medical thinking shifted is more complicated than a single announcement. For most of the 20th century, alcohol was considered harmless for pregnant women, and in some cases doctors actively encouraged it.
Centuries of Casual Acceptance
For most of recorded history, drinking during pregnancy was simply part of normal life. Beer and wine were dietary staples in many cultures, and pregnancy wasn’t treated as a reason to stop. Starting in the 1920s, the Guinness brewing company ran its famous “Guinness is good for you” campaign and wrote to every doctor in the UK soliciting testimonials. Many responded enthusiastically, describing how they prescribed stout to patients recovering from surgery and to pregnant women, based on the belief that it was rich in iron. That medical endorsement remained central to the Guinness brand for roughly 40 years.
Even earlier concerns about maternal drinking, which did surface during the temperance movements of the 19th century, were largely dismissed after Prohibition was repealed in the 1930s. The political backlash against temperance-era science meant that existing evidence linking alcohol to birth problems was buried. For decades afterward, the dominant medical view held that there was no risk to mother or fetus from drinking during pregnancy.
The First Clinical Evidence: 1968
The modern understanding began in France. In 1968, Dr. Paul Lemoine published a study describing 127 children born to mothers who drank heavily during pregnancy. These children shared a distinctive pattern of facial features and developmental symptoms tied to their prenatal alcohol exposure. It was the first large clinical documentation of what alcohol could do to a developing baby.
Lemoine’s work was published in a French-language journal and received almost no international attention at the time. The medical establishment was not ready to hear it. The pervasive belief that prenatal alcohol was safe persisted well into the 1970s, creating what researchers have described as a major barrier to changing both physician and public attitudes.
Fetal Alcohol Syndrome Gets a Name: 1973
The turning point came in 1973, when researchers at the University of Washington published a paper in The Lancet coining the term “fetal alcohol syndrome” (FAS). They described a recognizable pattern of birth defects in children born to mothers who drank heavily: growth problems, distinctive facial features, and central nervous system damage affecting learning, memory, attention, and behavior. This time, the English-language publication and the catchy diagnostic label caught the medical world’s attention.
Still, acceptance was slow. For the majority of the 20th century, the knowledge that alcohol is a teratogen (a substance that causes birth defects) was either unknown to most doctors or actively ignored. Many physicians continued to reassure pregnant patients that moderate drinking was fine.
Why a Fetus Can’t Handle Alcohol
The biological reason drinking during pregnancy is dangerous is straightforward: alcohol passes directly through the placenta. Ethanol and its toxic byproduct, acetaldehyde, are small enough molecules to cross from the mother’s blood into the baby’s blood with almost no resistance.
The critical problem is that a fetus can barely process alcohol. The liver enzymes responsible for breaking down alcohol in adults are almost nonexistent in a developing baby. In the second month of pregnancy, a human fetus has only 3 to 4 percent of an adult’s capacity to metabolize alcohol. That capacity increases gradually as the pregnancy progresses but never reaches adult levels before birth. This means that even when the mother’s body is clearing alcohol normally, the fetus is sitting in it far longer, with a metabolic burden far higher than an adult would experience from the same exposure.
The 1981 Surgeon General’s Advisory
The first official U.S. government warning came in 1981. Acting Surgeon General Edward Brandt advised women who were pregnant “or considering pregnancy” not to drink alcohol at all. This was a landmark moment, the first time the federal government took a clear public stance. In 2005, Surgeon General Richard Carmona reiterated the same recommendation, expanding outreach to a broader group of women and emphasizing that fetal alcohol spectrum disorders are entirely preventable through abstinence.
Congress also acted on the labeling front. Starting in 1989, all alcoholic beverages sold in the United States were required to carry a warning label about the risks of drinking during pregnancy.
Other Countries Were Even Slower
The U.S. was relatively early compared to some other nations. The United Kingdom didn’t adopt a full abstinence recommendation until 2016, when the Chief Medical Officers revised their guidelines and advised complete abstinence for women who are pregnant or planning a pregnancy. Before that, UK guidance allowed small amounts of alcohol, typically one to two units per week. The 2016 revision brought the UK in line with the many countries that already advised zero alcohol during pregnancy.
This patchwork of international guidelines helps explain why confusion persists. For decades, women in different countries received contradictory advice from their own doctors, ranging from “a glass of wine is fine” to “don’t touch a drop.”
What We Now Call Fetal Alcohol Spectrum Disorders
The science has expanded considerably since 1973. Fetal alcohol syndrome is now understood as just the most severe end of a wider range of conditions grouped under the term fetal alcohol spectrum disorders (FASDs). The spectrum includes partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects. Children on the less severe end of the spectrum may not have the recognizable facial features of FAS but can still have significant problems with memory, attention, impulse control, math skills, and daily functioning.
Diagnosis is difficult because there’s no blood test for FASDs. Clinicians piece together a picture from the child’s developmental history, behavioral patterns, and, when available, confirmation of prenatal alcohol exposure. Many children with FASDs are initially misdiagnosed with ADHD or other behavioral conditions.
Drinking During Pregnancy Today
Despite decades of warnings, alcohol use during pregnancy hasn’t disappeared. CDC data shows that nearly 14 percent of pregnant women in the U.S., roughly one in seven, reported having at least one drink in the past 30 days. About 5 percent, or one in 20, reported binge drinking (four or more drinks on a single occasion). The rate of current drinking among pregnant women actually increased from 9.2 percent in 2011 to 11.3 percent in 2018.
The gap between what science knows and what people do reflects how recently the consensus shifted. Many women alive today had mothers or grandmothers who were told by their own doctors that a beer would help with their iron levels or that a glass of wine would calm their nerves. The formal medical recognition that any amount of alcohol poses a risk during pregnancy is, in historical terms, remarkably recent: barely one generation old.