Discontinuation of treatment for alcohol use disorder during pregnancy and postpartum in the United States

作者：Caitlin E. Martin, Jennifer K. Bello, Bridget M. Galati, Joanna L. Buss, Mishka Terplan, Hendrée E. Jones, Kathleen T. Mitchell, Sílvia S. Martins, Richard A. Grucza, Elizabeth A. Suarez, Kevin Y. Xu · 发表于：Alcoholism Clinical and Experimental Research · 年份：2025 · DOI：10.1111/acer.70117 · 被引用次数：2 · 研究领域：Prenatal Substance Exposure Effects、Substance Abuse Treatment and Outcomes、Maternal Mental Health During Pregnancy and Postpartum

BACKGROUND: The degree of alcohol use disorder (AUD) treatment utilization during the perinatal period is unknown. We report the prevalence of preconception receipt of medications for AUD (MAUD) and psychosocial interventions (PSY), discontinuation during pregnancy, and postpartum resumption in a multi-state sample, comparing pregnant and nonpregnant people with AUD. METHODS: Using MarketScan combined commercial and Medicaid claims (2016-2019), we identified individuals with AUD who had continuous insurance coverage throughout pregnancy, classifying those with a live birth as pregnant, and compared their MAUD and PSY patterns to nonpregnant peers matched by age, insurance type, and calendar time. All individuals had ≥1 claim for: (a) AUD diagnosis and (b) MAUD or PSY in the year preceding the study. Outcomes-filled MAUD prescriptions (naltrexone, acamprosate, and disulfiram) and receipt of PSY-were identified via claims. We computed rates of MAUD and PSY receipt, stratifying by five observation windows for pregnant individuals (12-week preconception; first, second, and third trimesters; 12 weeks postpartum) and nonpregnant peers (by corresponding windows). We assessed time to treatment discontinuation using multivariable Cox regression, adjusting for sociodemographics and comorbidities. RESULTS: Our sample consisted of 2080 pregnant persons with AUD and 7564 matched nonpregnant AUD peers. During pregnancy, MAUD receipt declined from 12.1% (preconception) to 0.3% (third trimes...