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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\u2010state sample, comparing pregnant and nonpregnant people with AUD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using MarketScan combined commercial and Medicaid claims (2016\u20132019), 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 \u22651 claim for: (a) AUD diagnosis and (b) MAUD or PSY in the year preceding the study. Outcomes\u2014filled MAUD prescriptions (naltrexone, acamprosate, and disulfiram) and receipt of PSY\u2014were identified via claims. We computed rates of MAUD and PSY receipt, stratifying by five observation windows for pregnant individuals (12\u2010week preconception; first, second, and third trimesters; 12\u2009weeks postpartum) and nonpregnant peers (by corresponding windows). We assessed time to treatment discontinuation using multivariable Cox regression, adjusting for sociodemographics and comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Postpartum resumption of MAUD was uncommon in the pregnant cohort (pregnant\u2009=\u20091.9%; nonpregnant\u2009=\u20097.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). PSY declined for both the pregnant and nonpregnant cohorts yet remained modestly higher in the nonpregnant cohort (postpartum 10.3% vs. 13.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In adjusted analyses, pregnant people were more likely to discontinue MAUD than nonpregnant peers (HR\u2009=\u20092.11 [1.71\u20132.60]) yet not more likely to discontinue PSY (HR\u2009=\u20091.01 [0.87\u20131.17]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among pregnant people with preconception AUD receiving treatment, MAUD utilization is low and discontinuation is widespread, persisting postpartum.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70117","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T15:05:36Z","timestamp":1755961536000},"page":"1972-1982","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Discontinuation of treatment for alcohol use disorder during pregnancy and postpartum in the United States"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-458X","authenticated-orcid":false,"given":"Caitlin E.","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology and the VCU Institute for Drug and Alcohol Studies Virginia Commonwealth University School of Medicine  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer K.","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget M.","family":"Galati","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University in St. Louis School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna L.","family":"Buss","sequence":"additional","affiliation":[{"name":"Institute for Informatics, Data Science and Biostatistics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mishka","family":"Terplan","sequence":"additional","affiliation":[{"name":"Friends Research Institute  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendr\u00e9e E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of North Carolina School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen T.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"FASD United  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia S.","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Columbia University Mailman School of Public Health  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Grucza","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Suarez","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science Rutgers Institute for Health, Health Care Policy and Aging Research  New Brunswick New Jersey USA"},{"name":"Department of Biostatistics and Epidemiology Rutgers School of Public Health  Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6595-695X","authenticated-orcid":false,"given":"Kevin Y.","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington 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