Prenatal alcohol exposure is one of the nation’s most underrecognized drivers of lifelong mental, behavioral, developmental, and medical burden. The CDC shows that 1 in 7 or 14% of pregnant women report current drinking, and it warns that alcohol exposure before birth can result in FASDs (fetal alcohol spectrum disorders) and lifelong problems with behavior, learning, and physical health. Although the DSM-5 recognizes the psychiatric significance of prenatal alcohol exposure through ND-PAE, it fails to address the four profiles under the standardized FASD diagnosis. Nor do the current MAHA agenda and the Make Our Children Healthy Again reports appear to address PAE with the level of specificity its mental health impact warrants.