Background
Despite the U.S. Surgeon? warning on the effects of alcohol on the fetus, a substantial number of women continue to drink during pregnancy. Alcohol use in women is grossly underestimated, making it difficult to determine the prevalence of alcohol-exposed pregnancies. Further, there appear to be significant racial differences in diagnoses of Fetal Alcohol Syndrome in comparison to women? reports of drinking.

Objectives
To assess prevalence of alcohol-exposed pregnancy (AEP) risk in women of childbearing age residing in urban areas.

Methods
A random-digit-dial-survey of 1,882 women age 19-44 years was conducted in 2005 in two metropolitan areas in the Midwest. Multivariate logistic regression controlling for demographics and pregnancy status was conducted with moderate AEP risk versus heavy/binge drinking with AEP as the outcome.

Results
In two Midwest urban areas, we found 22.7% of women age 19-44 years to be at risk for an alcohol-exposed pregnancy. Prevalence of risk among White women was 29%, and for Black women 16.5%. Among pregnant women, a greater percentage of Black women reported heavy and binge drinking, though differences between races were not significant. Controlling for metropolitan area, age, education, race, employment, income, and pregnancy status, age and race were found to be significantly correlated with AEP risk, with White women aged 20-29 at highest risk.

Conclusions
White women are at higher risk for an alcohol-exposed pregnancy when compared to Black women, although this risk profile based on race may change for pregnant women. Awareness of the AEP risk is important in education of women and health care professionals in prevention initiatives designed to recognize and address the risk of an AEP.