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Therefore, variation in prevalence across the cohorts is likely to be driven by sociodemographic differences in the cohorts which influence true consumption levels, as well as measurement and reporting differences across the studies. Additionally, we have only included live born babies in our analysis and thus, there is a possibility that we have excluded women with the heaviest drinking patterns, since failure to give birth to a baby could have resulted from heavy drinking; for example, miscarriage occurring due to early pregnancy chronic alcohol use or binge drinking. Participants in our studies may also be more advantaged than the general population and thus, the generalisability of our findings to all pregnancies or more diverse populations may be reduced. Nonetheless, the cross-cohort comparison improves upon previously published single cohort analyses, since it shows gestational alcohol use to be prevalent and socially pervasive during pregnancy, as measured by various measurement methods and in Oxygenase different settings. Second, across different studies and settings, maternal smoking is a strong and consistent predictor of alcohol consumption in pregnancy. Additionally, from a methodological perspective, the analysis points to the need for an agreed convention by which to measure gestational alcohol use to avoid substantial variation and heterogeneity in estimates and predictors of gestational alcohol use in future studies. Our findings of a range of gestational alcohol use from 20 to 80% are largely consistent with studies of similar design for each cohort, respectively. In general, prospective ascertainment of exposure has been shown to be more accurate than retrospective reporting where it has been suggested that postpartum drinking levels and poorer memory after the fact could influence reporting.17 In the prospective SCOPE study, the high rates of pre-pregnancy and gestational alcohol consumption that were observed in Ireland are compatible with estimates from another large contemporary prospectively recruited urban Irish cohort (n=65?000) which had a similar prospective design but with both nulliparous and multiparous participants.18 However, GUI estimates are likely to substantially underestimate gestational alcohol consumption, especially when compared with 37% alcohol prevalence in the UK MCS, a cohort of almost identical design where exposure was measured 9?months postpartum.6 Potential reasons why GUI and MCS estimates are not compatible include differences in interviewing techniques and administration of surveys which would easily influence reporting of socially undesirable behaviours such as gestational alcohol use.