A retrospective cohort study published in Pregnancy found that rates of alcohol and cannabis use increased substantially from pregnancy to the postpartum period among people with HIV, with distinct risk factor profiles for each substance.
Both alcohol and cannabis use have grown more common among reproductive-age women in the United States over the past decade, including during pregnancy.
For pregnant people with HIV, substance use carries additional clinical consequences, including suboptimal antiretroviral therapy adherence and worsening HIV disease control, both of which contribute to adverse maternal and fetal outcomes.
Alcohol and cannabis use can also compound the mental health conditions that disproportionately affect them because of stigma, trauma, stress, and chronic illness.
The study authors noted that few studies have examined substance use patterns specifically during pregnancy and the postpartum period in this population.
The investigative team analyzed data from the Surveillance Monitoring for ART Toxicities study, which enrolled pregnant people with HIV at 22 US sites.
Among 1765 pregnancies with alcohol data, 8% reported alcohol use during pregnancy compared with 44% postpartum.
Among 1772 pregnancies with cannabis data, 8% reported use during pregnancy vs 14% postpartum.
Postpartum use patterns were categorized as never, initiation or resumption, continuation, or discontinuation.
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Multivariable models were used to identify factors associated with postpartum initiation or resumption among those without use during pregnancy.
The adjusted relative risk of postpartum alcohol initiation or resumption was lower for each additional year of age and for those with annual household income of $10,000 or less vs more than $30,000.
Risk was higher among participants from the Midwest vs the Northeast locations.
They were also more likely to have a cesarean birth and use tobacco during pregnancy.
Factors associated with postpartum cannabis initiation or resumption included younger age, lower household income, more recent delivery year, a psychiatric diagnosis during pregnancy, and tobacco use during pregnancy.
Younger age and tobacco use during pregnancy emerged as shared risk factors across both substances.
Psychiatric diagnosis and lower income were more specifically associated with postpartum cannabis use.
Understanding the clinical and obstetric characteristics associated with postpartum alcohol and/or cannabis use may enhance tailoring of interventions to optimize health among postpartum people with HIV.
The findings provide a foundation for a more tailored approach to supporting them with peripartum substance use.
