© 2015 Australasian Professional Society on Alcohol and other Drugs. Introduction and Aims: Alcohol use in pregnancy is thought to be common in remote Australian communities, but no population-based data are available. Aboriginal leaders in remote Western Australia invited researchers to determine the prevalence and patterns of alcohol use in pregnancy within their communities. Design and Methods: A population-based survey of caregivers of all children born in 2002/2003 and living in the Fitzroy Valley in 2010/2011 (n=134). Alcohol use risk was categorised using the Alcohol Use Disorders Identification Test consumption subset (AUDIT-C) tool. Birth and child outcomes were determined by interview, medical record review and physical examination. Results: 127/134 (95%) eligible caregivers participated: 78% were birth mothers, 95% were Aboriginal and 55% reported alcohol use in index pregnancies; 88% reported first trimester drinking and 53% drinking in all trimesters. AUDIT-C scores were calculated for 115/127 women, of whom 60 (52%) reported alcohol use in pregnancy. Of the 60 women who drank (AUDIT-C score≥1), 12% drank daily/almost daily, 33% drank 2-3 times per week; 71% drank≥10 standard drinks on a typical occasion; 95% drank at risky or high-risk levels (AUDIT-C score≥4). Mean AUDIT-C score was 8.5±2.3 (range 2-12). The most common drinking pattern was consumption of ≥10 standard drinks either 2-4 times per month (27%) or 2-3 times per week (27%). Discussion and Conclusions: High-risk alcohol use in pregnancy is common in remote, predominantly Aboriginal communities in north western Australia. Prevention strategies to reduce prenatal alcohol use are urgently needed.