Martin 2025: how often alcohol medicines are stopped in pregnancy

What they tested

Using MarketScan insurance claims from 2016 to 2019, covering commercial and Medicaid plans in several US states, researchers found people with alcohol use disorder who had continuous coverage through a pregnancy ending in a live birth. Each had an alcohol use disorder diagnosis and had received medicine or psychosocial treatment, such as counselling, in the year before.

They compared 2,080 pregnant people with 7,564 nonpregnant peers matched by age, insurance type and calendar time. Medicines counted were filled prescriptions for naltrexone, acamprosate and disulfiram, tracked from 12 weeks before conception through each trimester to 12 weeks after birth.

What they found

Medicine use fell from 12.1% before conception to 0.3% in the third trimester among pregnant people, and from 13.5% to 8.1% over the same period among nonpregnant peers (p < 0.001).

After birth, 1.9% of the pregnant group restarted an alcohol medicine, compared with 7.8% of nonpregnant peers.

Psychosocial treatment declined in both groups and stayed somewhat higher among nonpregnant peers (postpartum: 10.3% in the pregnant group vs 13.8%). After adjusting for other factors, pregnant people were more likely to stop medicine (hazard ratio 2.11) but not more likely to stop psychosocial treatment (hazard ratio 1.01).

Limits

• Claims show filled prescriptions, not whether people took the medicine or why they stopped.
• The three medicines were grouped together, so the abstract gives no separate figures for naltrexone.
• Only insured people with continuous coverage and a live birth were included.

What it means if you're considering naltrexone

Most people in this study stopped alcohol medicines during pregnancy, and very few restarted after the baby was born. The study can't say whether stopping was the right choice for any one person, but it shows that restarting treatment after birth is uncommon.