Prevalence of alcohol and opioid use, however, did not change

Among pregnant women living with HIV from 2007 to 2019, marijuana use, both during pregnancy and postpartum, increased over time, as did postpartum co-use of cannabis and alcohol, according to an analysis of the SMARTT study published in JAMA Network Open

“Marijuana use in the U.S. has increased among pregnant and nonpregnant individuals of reproductive age. Legalization of marijuana for medical and recreational use, as well as increased social acceptance of marijuana use, may contribute to these trends. Marijuana use during pregnancy is common, is often perceived to be safe, and has even been recommended by dispensaries for alleviation of pregnancy symptoms. Despite professional guidelines that discourage the prescription or use of marijuana during preconception, pregnancy, and lactation, it remains commonly used… Concurrent with evolving marijuana use, the opioid crisis in the U.S., driven largely by use of prescription opioids, is a complex public health challenge that extends to pregnant and other reproductive-aged individuals,” according to Lynn M. Yee, MD, MPH, and colleagues from the Pediatric HIV/AIDS Cohort Study.

“Examining substance use among pregnant and postpartum persons living with HIV is particularly important because these individuals experience comorbid medical and psychosocial conditions that enhance the risk of adverse perinatal outcomes,” they added.

To assess existing trends in marijuana, alcohol, and opioid use during pregnancy and year one postpartum, Yee and colleagues analyzed data from the Surveillance Monitoring for Antiretroviral Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study of pregnant women living with HIV at 22 U.S. sites from January 2007 to July 2019 who self-reported their substance use during pregnancy, at one year postpartum, or both.

The study authors included substance use data from 2,310 women living with HIV (mean age: 28.8 years; 28.1% Hispanic, 63.5% non-Hispanic Black; 6.3% White), and found that during the study, marijuana use during pregnancy increased from 7.1% to 11.7%. Alcohol and opioid use, however, remained unchanged.

In these women, postpartum alcohol use (44.4%), marijuana use (13.6%), and concomitant alcohol and marijuana use (10.0%) were common. From 2007 to 2019, postpartum marijuana use increased dramatically, from 10.2% to 23.7%, but postpartum alcohol use remained stable.

During pregnancy, the adjusted mean risk of marijuana use increased by 7% per year (95% CI: 3%-10%), and by 11% per year postpartum (95% CI: 5%-15%), while the postpartum use of concomitant alcohol and marijuana increased by a full 10% per year (95% CI: 5%-15%).

Researchers also noted that the differences in substance use were not associated with the legalization of recreational marijuana but were instead associated with the legalization of medical marijuana.

Yee and colleagues argued that “the 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.”

Editorialists Kelly C. Young-Wolff, PhD, MPH, of Kaiser Permanente Northern California, Oakland, and colleagues noted that despite the common use of cannabis by patients living with HIV to manage symptoms—both physical and mental health related—and chronic comorbidities, these results from Yee et al are compelling.

“The increasing prevalence of cannabis use during pregnancy and postpartum among people living with HIV seen in the study by Yee et al is concerning and deserves attention. Prenatal cannabis use has been associated with adverse fetal, neonatal, and neurodevelopmental outcomes. Postpartum cannabis use may also have unintended consequences for children, such as poisoning through unintentional ingestion, secondhand smoke exposure, or risks associated with driving or providing care for children while using cannabis. The American College of Obstetricians and Gynecologists strongly recommends that people abstain from cannabis use during pregnancy, yet a previous study suggested that some see cannabis as a safe and natural substance that can be used to mitigate depression, stress, and morning sickness,” they wrote in their accompanying editorial.

Ultimately, more screening by clinicians and further studies on why patients use cannabis both during and after pregnancy are needed, concluded Young-Wolff and colleagues.

“Clinicians should routinely screen for cannabis use in this population and provide patient-centered care to reduce potential harms. Further research is needed to understand factors that contribute to prenatal and postpartum cannabis use, the association of cannabis legalization with health outcomes and equity, and strategies to improve health services and outcomes for pregnant and postpartum people living with HIV,” they wrote.

Study limitations included potential social desirability biases in patients’ self-reported substance use; a lack of data on postpartum opioid use or indications for substance use; and only two SMARTT sties were located in states with legal recreational marijuana, which limits the study’s ability to analyze recreational marijuana legalization.

  1. Among pregnant women living with HIV from 2007 to 2019, marijuana use, both during pregnancy and postpartum, increased over time, as did postpartum co-use of cannabis and alcohol.

  2. The study authors argued that the 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.

Liz Meszaros, Deputy Managing Editor, BreakingMED™

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Office of the Director, National Institutes of Health; the National Institute of Dental and Craniofacial Research; the National Institute of Allergy and Infectious Diseases, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Cancer Institute, and the National Institute on Alcohol Abuse and Alcoholism through cooperative agreement HD052102 with the Harvard T.H. Chan School of Public Health and cooperative agreement HD052104 with the Tulane University School of Medicine and through a grant with Harvard T.H. Chan School of Public Health for the Pediatric HIV/AIDS Cohort Study.

Yee reported no disclosures.

Young-Wolff reported receiving grants from the National Institutes on Drug Abuse (NIDA) during the conduct of the study and outside the submitted work.

Cat ID: 339

Topic ID: 338,339,339,730,41,192,144,146,925

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