“Medical marijuana legalization may be associated with increased marijuana use in this population,” Yee and colleagues wrote. “These patterns of increasing marijuana use among pregnant and postpartum people living with HIV warrant enhanced clinical attention given the potential maternal and child health implications of substance use.”
People living with HIV were more likely to use marijuana during pregnancy after medical legalization compared to before (adjusted RR 1.36, 95% CI 1.02-1.80). In the postpartum period, both marijuana (adjusted RR 1.84, 95%CI, 1.40-2.42) and concomitant marijuana and alcohol use (adjusted RR 1.75, 95%CI, 1.25-2.45) were significantly more common after the legalization of medical use.
However, legalization of recreational marijuana did not have a significant impact on use in this population.
These trends are “concerning” and warrant attention, according to an accompanying editorial by Kelly Young-Wolff, PhD, MPH, of Kaiser Permanente Northern California, and colleagues.
Both prenatal and postpartum cannabis use have the potential to cause adverse fetal and childhood outcomes, and clinicians should advise against use in the pregnant patients, Young-Wolff and colleagues wrote.
However, the editorialists noted that marijuana has long been used by people living with HIV to manage the effects of medication, mental health conditions, or chronic illnesses — all of which are prevalent in this population. Patient-centered care, they stated, requires empathetic and nonjudgmental conversations about prenatal substance use.
Yee and colleagues evaluated marijuana, alcohol, and opioid use during pregnancy and the first year postpartum among patients living with HIV at 22 U.S. sites using data from the Surveillance Monitoring for Antiretroviral Toxicities (SMARTT) study of the multicenter, prospective Pediatric HIV/AIDS Cohort Study.
Substance use information was self-reported in interviews, which were conducted within a week after birth. Interviewers gathered information on the frequency and trimester of opioid, alcohol, and marijuana use. Then at 1 year postpartum, study participants underwent an exam via a mental health screening tool that assessed how often they used substances in the past 6 months.
There was no information in the study on whether opioids or marijuana were prescribed.
Yee’s group analyzed nearly 3,000 pregnancies from 2,300 people living with HIV. The mean age of pregnant patients was around 29. Most reported substance use occurred both during gestation and in the postpartum period.
Marijuana use increased among pregnant people living with HIV across the last decade, both in pregnancy and postpartum. The overall prevalence of marijuana use during pregnancy was 9.3% overall, peaking at 13.3% in 2013. Among those who used marijuana during pregnancy, most used it in the first trimester.
The mean annual increase of marijuana use during pregnancy was 7% (adjusted RR 1.07, 95% CI 1.03-1.10), and the mean annual increase in postpartum use was 11% (adjusted RR 1.11, 95% CI 1.07-1.16).
Substance use was most common in the postpartum period. The mean prevalence of alcohol use was 44%, marijuana use was 13.6%, and concomitant alcohol and marijuana use was 10%.
Postpartum alcohol use also increased from 2007 to 2012, jumping from 36.2% to 53.8%, but then declined to 42.1% by 2019.
ee’s group recognized a few limitations of their study, including its reliance on self-reported substance use data. The researchers also noted that the SMARTT study lacked data on postpartum opioid use and the indications for substance use, and they could not identify all forms of marijuana that were used by participants. Finally, because this study was limited to people living with HIV in perinatal care whose children were not infected with HIV, the results might not be generalizable to all populations.
Young-Wolff’s group noted that this study primarily included patients who were Black or Latinx, reflecting the higher risk of HIV infection among these populations compared with white people.
“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.
By Amanda D’Ambrosio
JAMA Network Open
Source Reference: Yee L, et al “Marijuana, Opioid, and Alcohol Use Among Pregnant and Postpartum Individuals Living With HIV in the US” JAMA Netw Open 2021; DOI: 10.1001/jamanetworkopen.2021.37162.
JAMA Network Open
Source Reference: Young-Wolff K, et al “Cannabis Use and Patient-Centered Care During Pregnancy and Post Partum Among People Living With HIV” JAMA Netw Open 2021; DOI:10.1001/jamanetworkopen.2021.37588.