Background: No- and low-alcohol (NoLo) products are promoted as harm-reduction alternatives to standard alcohol, but their role in pregnancy is unclear. We examined pregnant and recently pregnant women’s perceptions of NoLo-related harm, how perceptions relate to drinking, and women’s information preferences.

Methods: A cross-sectional mixed-methods online survey, completed by 515 UK women, who were currently/recently pregnant. Participants rated harm of standard-strength alcohol, NoLo (0.0–1.2% ABV), and alcohol-free (≤0.05%) drinks, reported drinking during pregnancy, and provided open-text responses about NoLos.

Results: Standard-strength alcohol was perceived as most harmful, followed by NoLo and alcohol-free drinks (p<.001). Women aware of abstinence guidelines and who did not drink during pregnancy rated all alcohol-containing drinks as more harmful. Greater perceived harm of standard (OR = 0.98, 95% CI = 0.97–0.99) and NoLo (OR = 0.97, 95% CI = 0.96–0.99) drinks was associated with lower odds of pregnancy drinking. Sensitivity analyses indicated these associations were product-specific. Qualitative findings revealed widespread confusion around NoLos, concerns about labeling, and strong preferences for clear, clinician-led guidance.

Conclusions: NoLo products occupy a psychologically ambiguous space in prenatal alcohol decision-making. Women make distinct risk assessments for different beverage types during pregnancy, yet remain uncertain about NoLo products. Clearer regulation, labeling, and evidence-based pregnancy-specific guidance are needed for informed decision-making.