Martin Caitlin E, Bello Jennifer K, Galati Bridget M, Buss Joanna L, Terplan Mishka, Jones Hendrée E, Mitchell Kathleen T, Martins Silvia S, Grucza Richard A, Suarez Elizabeth A, Xu Kevin Y
Department of Obstetrics and Gynecology and the VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Alcohol Clin Exp Res (Hoboken). 2025 Aug 23. doi: 10.1111/acer.70117.
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.
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.
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 trimester) among pregnant people and from 13.5% to 8.1% in nonpregnant peers during the equivalent time period (p < 0.001). Postpartum resumption of MAUD was uncommon in the pregnant cohort (pregnant = 1.9%; nonpregnant = 7.8%, p < 0.001). PSY declined for both the pregnant and nonpregnant cohorts yet remained modestly higher in the nonpregnant cohort (postpartum 10.3% vs. 13.8%, p < 0.001). In adjusted analyses, pregnant people were more likely to discontinue MAUD than nonpregnant peers (HR = 2.11 [1.71-2.60]) yet not more likely to discontinue PSY (HR = 1.01 [0.87-1.17]).
Among pregnant people with preconception AUD receiving treatment, MAUD utilization is low and discontinuation is widespread, persisting postpartum.
围产期酒精使用障碍（AUD）治疗的利用率尚不清楚。我们报告了在一个多州样本中，孕前接受AUD药物治疗（MAUD）和心理社会干预（PSY）的患病率、孕期停药情况以及产后恢复情况，并比较了患有AUD的孕妇和非孕妇。
利用MarketScan综合商业保险和医疗补助索赔数据（2016 - 2019年），我们识别出在整个孕期都有连续保险覆盖的患有AUD的个体，将有活产的个体归类为孕妇，并将他们的MAUD和PSY模式与年龄、保险类型和日历时间匹配的非孕妇同龄人进行比较。所有个体在研究前一年都有≥1次以下索赔：（a）AUD诊断和（b）MAUD或PSY。通过索赔确定开出的MAUD处方（纳曲酮、阿坎酸和双硫仑）和接受PSY的情况。我们计算了MAUD和PSY接受率，按孕妇的五个观察窗口（孕前12周；孕早期、孕中期和孕晚期；产后12周）和非孕妇同龄人（按相应窗口）进行分层。我们使用多变量Cox回归评估治疗停药时间，并对社会人口统计学和合并症进行了调整。
我们的样本包括2080名患有AUD的孕妇和7564名匹配的患有AUD的非孕妇同龄人。在孕期，孕妇中MAUD的接受率从孕前的12.1%下降到孕晚期的0.3%，同期非孕妇同龄人从13.5%下降到8.1%（p < 0.001）。产后恢复MAUD在孕妇队列中并不常见（孕妇 = 1.9%；非孕妇 = 7.8%，p < 0.001）。孕妇和非孕妇队列中的PSY接受率均下降，但非孕妇队列中仍略高（产后分别为10.3%和13.8%，p < 0.001）。在调整分析中，孕妇比非孕妇同龄人更有可能停用MAUD（风险比[HR] = 2.11 [1.71 - 2.60]），但停用PSY的可能性没有更高（HR = 1.01 [0.87 - 1.17]）。
在孕前患有AUD且接受治疗的孕妇中，MAUD的利用率较低，停药情况普遍，且产后仍持续存在。
