Marijuana use by HIV-infected people during pregnancy and after childbirth has increased over time, with drug use generally becoming more prevalent after childbirth.
Marijuana use by people with HIV during pregnancy and after childbirth has increased over time and in states with legal medical marijuana, a cohort study published in JAMA Network is open have found.
The study also found that opioid and alcohol use during pregnancy did not change much, but still occurred at relatively high rates.
The researchers collected data from 2,926 pregnancies among 2,310 people living with HIV who were enrolled in the SMARTT Surveillance Study, and the mean age (SD) was 28.8 (6.1) years.
Marijuana use during pregnancy increased from 7.1% in 2007-2008 to 11.7% in 2018-2019, with an overall prevalence of 9.3%. Additionally, the prevalence peaked at 13.3% in 2013.
Specifically, the prevalence of opioid and alcohol use during pregnancy remained relatively stable, with the prevalence of opioid use dropping from 5.8% in the first study period to 3.9% in the second study period, and alcohol use barely declining from 8.6% to 8.2% at the same time. However, both had high prevalence between study periods, with opioid use peaking at 8.7% in 2012 and alcohol use peaking at 11.8% in 2013. Alcohol and associated marijuana use was also generally low and stable, up from 1.8% to 2.8%, but again saw a high of 5.2% in 2014.
Postpartum drug use was more common across the board, with an average prevalence of 44.4% for alcohol, 13.6% for marijuana, and 10.0% for associated alcohol and marijuana.
The prevalence of marijuana use during the postpartum period increased significantly, from 10.2% to 23.7%. Postpartum alcohol use also increased from 36.2% in 2007-2008 to 53.8% in 2012, but declined again to 42.1% in 2018-2019. Concomitant alcohol and marijuana use after childbirth, as during pregnancy, was generally less prevalent, but still increased from 6.7% to 15.8% between the first and last study periods.
More specifically, drug use in general was more common in the first trimester of pregnancy and in the postpartum period. Consistent with other studies, these data indicate that the prevalence of drug use decreases as pregnancy progresses, possibly due to alleviation of nausea or awareness of pregnancy.
“These patterns of increased marijuana use among pregnant and postpartum people living with HIV suggest that enhanced clinical attention is required, given the potential effects on maternal and child health of drug use,” the study authors said.
According to the authors, the adjusted mean risk of marijuana use increased by 7% (95% CI, 3%-10%) per year during pregnancy and 11% (95% CI, 7%-16%) per year after childbirth, and alcohol and marijuana use increased Birth-associated at 10% (95% CI, 5%-15%) per year.
They also found that differences in the prevalence of drug use were not related to recreational legalization, but marijuana use was related to the medical legalization of marijuana.
“Marijuana use was higher among people living in the states and during periods of medical marijuana legalization,” the authors said. “Understanding how the opioid crisis and evolving legal policies on marijuana relate to drug use among pregnant and postpartum people with HIV has important public health implications for pregnancy-related health and HIV.”
A previous analysis of SMARTT data showed that overall rates of drug use declined sharply from 1990 to 2012 in HIV-positive pregnant women; However, substance use was defined more broadly in this analysis. The authors also cite the current opioid epidemic and changes in marijuana legalization as major potential factors for increasing prevalence of drug use among HIV-positive and postpartum pregnant women.
“In addition, the potential association of marijuana use with adherence to ART should be considered,” the authors said. They added that “although marijuana may be positively associated with adherence if it alleviates nausea, for example, the potentially harmful associations of drug use in relation to perinatal transmission of HIV represent important aspects of counseling.”
Yee LM, Kacanek D, Brightwell C et al. Marijuana, opioid, and alcohol use among HIV-positive pregnant and postpartum women in the United States. Gamma neto is open. Published online December 3, 2021. doi: 10.1001/jamanetworkopen.2021.37162