Objective: Official guidelines advocate abstinence from alcohol during pregnancy. However, a number of women consume alcohol while pregnant. Understanding women’s reasons and the context for drink- ing during pregnancy outside the context of an alcohol use disorder may be helpful for interventions of healthcare providers and health policymakers. This paper reports a systematic review of qualitative stud- ies focusing on women’s perspectives of the issue of alcohol consumption during pregnancy on one hand, and on recommendations on the other. Design: Seven electronic databases and citation lists of published papers were searched for peer-reviewed articles published between 2002 and 2019 in English and French, reporting primary empirical research, using qualitative design and exploring women’s views and experiences about the issue of alcohol and pregnancy. Studies involving participant women identified as having an alcohol use disorder while preg- nant were excluded. Using the thematic synthesis method, we extracted and coded findings and recom- mendations from the selected studies. Setting and participants: Women who mostly reported being abstinent or having reduced their alcohol consumption during pregnancy, and non-pregnant women Findings: We included 27 studies from 11 different countries. The quality of studies was assessed using the CASP tool. We developed five analytical themes synthesising women’s views and experiences of ab- stinence and occasional alcohol consumption during pregnancy: lack of reliable information; inadequate information from health professionals; women’s perception of public health messages; women’s experi- ences and perception of risk; and social norms and cultural context. Six analytical themes synthesising recommendations were generated: improving health professionals’ knowledge and screening practice; di- versification of information sources; improving women’s information; empowering women’s choice; de- livering appropriate messages; and addressing socio-structural factors. Key conclusions: Our review provides evidence that information on the issue of alcohol consumption during pregnancy should be improved in both qualitative and quantitative terms. However, the reasons for pregnant women’s occasional drinking are complex and influenced by a range of socio-cultural fac- tors. Therefore, healthcare professionals and policymakers should take into account women’s experiences and the context of their everyday lives when conveying preventive messages. Our review demonstrates that awareness strategies should not focus solely on women’s individual responsibility. They should also address a wider audience and foster a more supportive socio-structural environment. Implications for practice: The understanding of women’s perspective is essential to designing sound pre- vention interventions and credible messages. Our review provides a comprehensive summary of the state of qualitative research on women’s experience of the risk of alcohol use during pregnancy, as well as the literature’s recommendations about how to address this issue. This review also contributes to identifying overlooked areas of recommendations that require further reflection and research.