Purpose: The Centers for Disease Control and Prevention has experienced a rough ride in the wake of new public health outreach defining “any alcohol use by women who are pregnant or might be” as drinking too much. Since half of US pregnancies are unplanned and effects of fetal alcohol exposure can be devastating, the guidance recommends that all women planning a pregnancy or not using reliable contraception abstain from alcohol. The CDC guidance presumes women who desire a pregnancy in the near term will abstain. We aimed to test this hypothesis and document patterns of alcohol use around conception and early pregnancy. We also investigated association of various maternal characteristics with risk of continued drinking. Methods: Right From the Start (2000-2012) is a prospective, community-based pregnancy cohort. Maternal demographic, reproductive, and behavioral data were collected in telephone interviews at enrollment (mean ± SD: 48 days ± 13 days gestation) and in the first trimester (mean ± SD: 85 days ± 21 days). The interviews included detailed information about alcohol consumption including: current/past use, amount, frequency, type of alcohol, binge drinking, and changes in pattern of use. We used logistic regression to investigate the independent association of intendedness with alcohol use in pregnancy. Results: Among 5,036 women, 55.3% reported using alcohol in the 12 weeks preceding the first trimester interview. Six percent reported continued use at the interview. Pregnancy was planned by 3,563 women and unintended by 1,473. Alcohol use occurred in 54% of intended pregnancies and 56% of unintended pregnancies. Adjusting for potential confounders including maternal age, parity, education, ethnicity, income, and BMI, women with intended pregnancies were 42% less likely to consume alcohol in pregnancy (adjusted OR (AOR) 0.58, 95% CI 0.49-0.69). Women who were older, white, college educated, had higher incomes, and having their first pregnancy were most likely to use alcohol in pregnancy, adjusting for intention. Binge drinking episodes were also less likely among the intended pregnancies (18% vs 27%, AOR 0.75, 95% CI 0.61-0.93). Characteristics associated with binge drinking included younger age, being unmarried, past or current smoking, and illicit drug use. Conclusion: Our results suggest a next phase of research focusing on fetal outcomes of these common patterns of alcohol use in pregnancy. Attention to decreasing the likelihood of alcohol use during pregnancy might be more fruitful when based on maternal predictors not often viewed as warning signs for drinking (e.g. older age, white race/ethnicity, college educations, etc) in comparison to typical signs associated with binge drinking. Public health messages aimed at informing women about risks of alcohol use in pregnancy should be mindful that although women intending pregnancy are less likely to drink and binge during pregnancy, consumption in this group is still concerning.