Previous research states that American Indian/Alaska Native pregnant women exhibit high rates of alcohol use and smoking. The current study uses the National Survey of Drug Use and Health (2005-2009) to update and expand on this literature. Results reveal lower rates of alcohol use and, with compositional controls, lower rates of smoking for American Indian/Alaska Native pregnant women compared with pregnant women of other racial/ethnic groups. These findings support social-structural explanations of substance use among American Indian/Alaska Native pregnant women and refute commonly offered cultural arguments that alcohol use and smoking reflect something that is "uniquely Indian."