Marijuana, Opioid, and Alcohol Use Among Pregnant and Postpartum Individuals Living With HIV in the US

Abstract

This cohort study evaluates trends over time in the prevalence of self-reported opioid, alcohol, and marijuana use during pregnancy and in the first year postpartum among people living with HIV and assesses the association of marijuana legalization status with substance use.

Cannabis Use and Patient-Centered Care During Pregnancy and Post Partum Among People Living With HIV

“…Those findings are somewhat consistent with recent data from a repeated cross-sectional study6 of women in 4 US states in the Pregnancy Risk Monitoring System, which found that legalization of recreational cannabis use was associated with increases in preconception and postpartum cannabis use but not prenatal cannabis use. However, while the results of the analysis on cannabis legalization by Yee et al3 are provocative, causal interpretation is limited by the cross-sectional nature of the analyses and the small sample size of pregnancies in states with legal recreational cannabis during the study period.Additional research is critically needed to examine the association of cannabis policies with the prevalence and frequency of cannabis use-as well as how cannabis is ingested (eg, smoking, vaping, Criminalization of cannabis has been a major driver of mass incarceration and racial inequity in the US. Legalization of cannabis could reduce criminalization-related harms, particularly among Black people, who are at substantially higher risk of arrest for cannabis possession than White people.…”

“…Yee et al 3 adjusted for race and ethnicity in their analyses, precluding the exploration of racial or ethnic disparities in cannabis use during pregnancy and post partum. In future studies of substance use during pregnancy and post partum, stratification by race and ethnicity and measurement of exposure to systemic racism 7 can better elucidate disparities and opportunities for structural intervention to improve health equity.Yee and colleagues3 have identified an increasing risk of prenatal and postpartum cannabis use among people living with HIV. Clinicians should routinely screen for cannabis use in this population and provide patient-centered care to reduce potential harms.…”

“…Using data from the Surveillance Monitoring for Antiretroviral Toxicity Study (SMARTT) of the Pediatric HIV/AIDS Cohort Study, Yee and colleagues examined trends in use of cannabis, alcohol, and opioids during pregnancy and 1 year post partum in a large sample of people living with HIV (mean age, 29 years; 64% non-Hispanic Black and 28% Hispanic) who gave birth between 2007 and 2019 at 22 US sites. Results indicated that the risk of cannabis use during pregnancy and post partum and co-use of cannabis and alcohol post partum increased significantly from 2007 to 2019.…”

“…In contrast, risk of alcohol and opioid use during pregnancy and alcohol use post partum were stable over time (postpartum opioid use was not measured). Yee and colleagues also assessed whether the risk of cannabis and alcohol use during pregnancy and post partum varied with state legalization of cannabis for recreational or medical use. They found that the risk of cannabis use during pregnancy or post partum did not differ by recreational cannabis legalization status; however, risk of cannabis use during pregnancy and post partum was higher among people living with HIV who were pregnant after vs before medical cannabis became legal in their state.…”

The impact of correlated exposures and missing data on multiple informant models used to identify critical exposure windows

“…In particular, HIV researchers are increasingly interested in evaluating how maternal trimester-specific exposures affect child health outcomes. These exposures during pregnancy include unsuppressed viral load (VL), 9 social determinants of health, 10 substance use, 11 and insurance coverage, 12 which are often included in regression models as binary indicators. Although there is extensive research on evaluating continuous exposures across exposure windows, [1][2][3][4][13][14][15][16][17][18][19] much less is known about the statistical properties of models evaluating binary exposure measures across windows of exposure.…”