A significant number of college women are at risk for alcohol-exposed pregnancy (AEP) owing to binge drinking paired with using contraception ineffectively. This article describes a randomized controlled trial of a one-session motivational interviewing-based intervention to reduce AEP risk among college women and presents 1-month outcomes demonstrating the early impact of this intervention. There were 228 female students from a mid-Atlantic urban university enrolled in the trial. Eligibility criteria were being in the age range of 18–24 years and being at risk for AEP. Risk for AEP was defined as having sexual intercourse with a man in the past 90 days while using contraception ineffectively (no use, incorrect use of an effective method, or use of an ineffective method only); drinking at risky levels was defined as engaging in at least one binge in the past 90 days or consuming an average of eight standard drinks per week. One-month outcome data were available for 212 of the 228 enrolled women (a follow-up rate of 93%), with complete data available for 105 women assigned to the control condition and 94 assigned to the intervention condition. At 1-month follow-up, 15% of the control subjects and 25% of the intervention women reported no risk drinking, a significant difference favoring the intervention group. Significantly fewer control subjects (48%) used effective contraception at 1-month follow-up as compared with intervention women (64%), χ2(1) = 5.1, p < .03. Significantly more intervention women (74%) were no longer at risk for AEP at 1 month as compared with control subjects (54%), χ2(1) = 8.15, p < .005. Factors that were associated with continued AEP risk at 1-month follow-up were a higher number of standard drinks per day consumed in the month prior to baseline (odds ratio, 1.1) and assignment to the control condition (odds ratio, 2.9). The risks of unintended pregnancy and AEP among drinking women in college merit greater prevention efforts. The results of this study show the promise of one preventive intervention that warrants additional study.