Opioid Use Among HIV-Positive Pregnant Women and the Risk for Maternal–Fetal Complications

Ngoc H. Nguyen, PharmD; Erika N. Le, PharmD; Vanessa O. Mbah, PharmD; Emily B. Welsh, PharmD; Rana Daas, BS; Kiara K. Spooner, DrPH, MPH; Jason L. Salemi, PhD, MPH; Omonike A. Olaleye, PhD, MPH; Hamisu M. Salihu, MD, PhD

Disclosures

South Med J. 2020;113(6):292-297. 

In This Article

Abstract and Introduction

Abstract

Objective: To assess patient- and hospital-level characteristics associated with opioid use in human immunodeficiency virus (HIV)–positive pregnant women and fetal health outcomes.

Methods: Using the 2002–2014 Nationwide Inpatient Sample database, we analyzed discharge records to describe the rates of opioid use among HIV-positive pregnant women. Logistic regression was used to quantify the magnitude of the association between exposure status and maternal–fetal outcomes.

Results: Opioid use was fourfold greater among HIV-positive pregnant women compared with their HIV-negative counterparts (odds ratio 4.0; 95% confidence interval 3.15–5.12). Relatively smaller but significant increases in the early onset of delivery, poor fetal growth, abortive pregnancy, and spontaneous abortion also were observed in association with HIV-positive status and opioid drug use during pregnancy.

Conclusions: An increased risk of negative maternal–fetal complications persists among HIV-positive women who use opioids during pregnancy. Focusing on predisposing factors and monitoring opioid dispensing may mitigate overuse or abuse in this vulnerable population.

Introduction

The United States is in the midst of an opioid epidemic. The increase in opioid misuse and addiction has led to an increase in deaths from drug overdose.[1] In 2016, >42,000 deaths were due to opioid overdoses; with an estimated 40% involving a prescription opioid.[2] Infectious disease outbreaks (eg, human immunodeficiency virus [HIV], hepatitis C virus), healthcare spending, drug misuse–related emergency department visits,[3] and opioid use and misuse among pregnant women[1] also have been attributed to the opioid epidemic. Considered a public health crisis and national emergency, increased prevention efforts, overdose reversal drugs, and access to opioid addition treatment are necessary to combat this epidemic.[4]

In recent years, opioid use in pregnancy has paralleled the epidemic of the general nonpregnant population.[5,6] Research indicates that women who use opioids while pregnant have higher rates of anxiety, depression, acute cardiac events, and certain chronic diseases, including diabetes mellitus and hypertension.[7,8] Opioid use among pregnant women also has been found to be associated with an increased occurrence of preterm labor, poor fetal growth, and stillbirth.[7] More specifically, maternal opioid use during the periconceptional period has been linked to an increased risk of birth defects, such as spina bifida,[9] gastroschisis, and congenital heart defects.[10] The upsurge of opioid use in pregnancy also has resulted in an increase in infants born with neonatal abstinence syndrome (NAS), a group of withdrawal symptoms that develop after birth. The signs and symptoms of NAS often are categorized by the affected systems, including central and autonomic nervous and gastrointestinal systems.[11] The onset and severity of symptoms vary, but may include sleep disturbances, feeding difficulties, seizures, and irritability.[11] Other symptoms, including social and behavioral problems, may persist beyond the neonatal period.[12]

With the recent increase in opioid use, there is also an increased risk of the spread of HIV among injection drug users.[13] In 2015, 9% of new HIV diagnoses were attributed to injection drug use.[14] Of the 232,692 women in the United States diagnosed as having HIV, approximately 8500 give birth annually.[15,16] Considering this, concern has been growing regarding the national opioid crisis among HIV-positive pregnant women and the increased risk of maternal–fetal complications. Data related to opioid use among HIV-positive pregnant women are scant, however. For these reasons, we undertook this study to assess the extent of the epidemic among this group of women and the impact on pregnancy outcomes.

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