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Description: Background: High levels of alcohol use in pregnancy have been shown to be associated with negative physical health consequences in offspring. However, the literature is less clear on the association of alcohol use in pregnancy and offspring mental health disorders. We conducted a systematic review to evaluate studies examining this association. Methods: Studies were identified by searching PsycINFO, PubMed and Web of Science, and were included if they examined alcohol use during pregnancy as an exposure and offspring mental health at age 3 or older as an outcome. We excluded non-English language publications, and studies of foetal alcohol syndrome. Results: Thirty-three studies were included and were categorised by mental health outcomes: anxiety/depression, emotional problems, total internalising problems, total problem score, and conduct disorder. Over half of the analyses reported a positive association of intrauterine alcohol exposure and negative offspring mental health outcomes. Conclusions: Our review suggests that maternal alcohol use during pregnancy is associated with negative offspring mental health outcomes, even at low to moderate levels of alcohol use. Future investigation using methods that allow stronger causal inference are needed to further investigate if these associations shown are causal.