There has been concern since antiquity that the ingestion of alcohol by the pregnant woman could damage the fetus, but it was not until 1973 that the fetal alcohol syndrome was first described. The broad effect of alcohol-related birth defects, including fetal alcohol effects (FAE), has become apparent even more recently. Physicians can play a central role in the prevention of alcohol-related birth defects through early detection, education of the mother, and appropriate referrals. This paper reviews the effects of maternal alcohol use on the fetus, discusses the importance of assessing alcohol use among all women of child bearing age, and examines intervention strategies that physicians can use to help pregnant women stop or reduce alcohol use. Funding for this paper was provided by the Maternal and Child Health Block Grant.