Alcohol Use Disorder is Profoundly Under-Treated During and After Pregnancy, Leaving Parents and Infants at Risk

Medication for Alcohol Use Disorder (AUD) drops precipitously during pregnancy and is rarely resumed following delivery, according to an analysis of a large cohort of adults treated for AUD. In recent years, binge drinking and AUD rates during pregnancy have increased significantly in the United States, eclipsing even opioids. Evidence-based treatments for AUD include medications and counseling. Still, these are underused, including during pregnancy when both the health of the parent and the development of the fetus are at risk from alcohol consumption. This reflects, in part, the absence of clinical treatment guidelines, insufficient data on the safety of AUD medicines for the fetus, and stigma around substance use during pregnancy. For the study in ^[1]Alcohol: Clinical & Experimental Research, investigators drew from an extensive national medical claims database to explore rates of medicinal and psychosocial treatments for AUD before, during, and after pregnancy.

To understand how alcohol medication receipt compared between pregnant and non-pregnant patients who were receiving treatment for AUD, the authors matched 2,080 pregnant people with 7,564 non-pregnant peers. They subsequently tracked—trimester by trimester—receipt of alcohol medications in pregnant patients, comparing discontinuation rates in the pregnant population with rates during the equivalent period in non-pregnant patients.  The authors found that in the 12 weeks before conception (and an equivalent timeframe for non-pregnant participants), 12% of the pregnant participants and 13% of the non-pregnant participants received medication for AUD, respectively. For both groups, the rate of alcohol medication receipt fell during pregnancy (or its equivalent period in non-pregnant peers); however, the observed decline was far more dramatic in the pregnant cohort. By the third trimester (or equivalent), 0.3% of pregnant people and 8% of nonpregnant people were receiving AUD medication, respectively. The rates of alcohol medication receipt for people who had given birth rose marginally in the 12 weeks following delivery.

Window of opportunity

The authors concluded that, in contrast to the concept of pregnancy as a window of opportunity for healthy behavior change, these data suggest that pregnancy may instead predict AUD treatment discontinuation. The study revealed major gaps in AUD treatment during pregnancy and the postpartum period, and highlighted opportunities for improving outcomes.

References:

1. Martin, Caitlin E., Jennifer K. Bello, Bridget M. Galati, Joanna L. Buss, Mishka Terplan, Hendrée E. Jones, Kathleen T. Mitchell et al. "Discontinuation of treatment for alcohol use disorder during pregnancy and postpartum in the United States." Alcohol: Clinical and Experimental Research (2025).

(Newswise/RBD)