This study examined the relationship between pregnancy intention and change in perinatal alcohol use between 3 months prior to pregnancy and the last 3 months of pregnancy from a large national sample of women in the United States, the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS). The study sample consisted of 95,728 women who reported any alcohol drinking in the 3 months prior to pregnancy. There was no relationship between pregnancy intention and cessation or reduction in alcohol use. Those whose pregnancies were unwanted were significantly more likely to report binge drinking during pregnancy compared to women with intended/mistimed pregnancies (AOR 1.55 [95% CI: 1.20, 1.99]). These findings suggest that interventions targeting binge drinking, perhaps particularly among women who drink in the 3 months prior to pregnancy and who do not want to become pregnant, are needed.