Marijuana use among pregnant and postpartum women living with HIV has increased, according to research published in JAMA Network Open.
Investigators reviewed data from the Surveillance Monitoring for Antiretroviral Toxicities Study (SMARTT) prospective cohort study of the National Institutes of Health’s Pediatric HIV/AIDS Cohort Study, which collects data of mothers and newborn babies during pregnancy or within 72 hours of delivery at enrollment and annually. Cohort members who enrolled between 2007 and July 2019 were included in the study.
Participants (n=2926 pregnancies of 2310 people) self-reported substance use (narcotic pain medications, heroin, opium, methadone, alcohol, or marijuana) through pregnancy in interviews conducted within 1 week of delivery date. At 1 year postpartum, they reported via the Client Diagnostic Questionnaire how often they had used these substances within the prior 6 months. Hazardous alcohol use was 28 or more drinks per month or at least 4 drinks at 1 occasion, while frequent marijuana use was at least 3 times per week.
A total of 21 individuals reported substance use postpartum but not during pregnancy, 1,131 reported substance use during pregnancy but not postpartum, and 1,774 reported both. Overall, opioid use, alcohol use, and concomitant alcohol and marijuana use remained stable. Alcohol use and marijuana use during pregnancy tended to occur in first trimester while opioid use was not linked with a particular trimester.
Prevalence of marijuana use during pregnancy increased from 7.1% in 2007-2008 to 11.7% in 2018-2019, peaking at 13.3% in 2013.
Substance use mean prevalence tended to rise after pregnancy. Marijuana use postpartum increased from 10.2% in 2007-2008 to 23.7% in 2018-2019, and concomitant postpartum alcohol and marijuana use rose from 6.7% in 2007-2008 to 15.8% in 2018-2019.
Marijuana use increased a mean 7% annually. Postpartum, the mean annual increase was 11%, with a 10% mean annual increase in concomitant alcohol and marijuana. Marijuana and concomitant alcohol and marijuana tended to be frequently used more by postpartum women in states after medical marijuana legalization (adjusted Relative Risk (RR) 1.84 marijuana, 1.75 alcohol, and marijuana) compared with before legalization.
Marijuana use was more common in pregnancies that occurred after legalization (adjusted RR 1.36) compared with before legalization. Alcohol use during pregnancy tended to decrease after medical marijuana legalization (adjusted RR 0.68) and in never legal states (adjusted RR 0.60). Concomitant alcohol and marijuana use was less likely in pregnancies in areas where medical marijuana was never legal compared with pregnancies that occurred before legalization (adjusted RR 0.37). Frequent marijuana use postpartum rose from 3.2% in 2008 to 9.1% in 2015 to 18.4% in 2018.
“Our data highlight the importance of integrating substance use counseling with family planning care for people living with HIV, for whom timing pregnancy is essential because of the importance of optimization of antiretroviral therapy before conception as well as optimization of other determinants of perinatal health,” the researchers said.
“…[T]he high prevalence and increasing frequency of postpartum marijuana use provide a call to action for practitioners of interconception care to counsel patients about reducing substance use for maternal and family health, even after the heightened risk period of pregnancy is over.”
Yee LM, Kacanek D, Brightwell C, et al. Marijuana, opioid, and alcohol use among pregnant and postpartum individuals living with HIV in the US. JAMA Network Open. Published online December 3, 2021. doi:10.1001/jamanetworkopen.2021.37162