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Significant numbers of women continue to consume alcohol while pregnant despite evidence of a range of possible serious consequences. Experts agree that a better understanding of the factors that influence this behavior is needed in order to develop more effective prevention strategies. However, research to date is often based on nonrepresentative samples and has failed to take a comprehensive, theory-driven approach to examining risk and protective factors. Based on a review of the literature, a risk-protective model of prenatal alcohol consumption, containing four domains of influence – individual risk, social/environmental risk, individual protective, and social/environmental protective – was developed. Data from the 2001 and 2002 National Survey on Drug Use and Health (NSDUH), formerly the National Household Survey on Drug Abuse, was then used to test this model to identify those domains, as well as specific predictors within each domain, that appear to be most influential at promoting or prohibiting alcohol consumption during pregnancy. Differences among White, Hispanic, and Black respondents were also explored. Findings from this study build upon prior research, confirming that certain risk factors are associated with a greater likelihood of drinking during pregnancy, as well as represent a starting point for the identification of factors that may actually help pregnant females refrain from consuming alcohol. Based on data from 1,814 pregnant females, the individual risk domain emerged as the most influential in predicting alcohol use during pregnancy, with cigarette smoking remaining a significant predictor across all three ethnic subgroups studied. A variable in the social/environmental risk domain, which was related to alcohol consumption among one’s social network, was significant among Hispanic respondents and spirituality, an individual protective domain factor, was associated with a decreased risk for alcohol use among Black pregnant females. Implications for future research, continued development of theory-based models of prenatal alcohol use, professional practice with childbearing aged women, and national and institutional policy, are also discussed.