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

Discussion

This study documents opioid use among HIV-positive pregnant women and the associated negative maternal and fetal outcomes. Our findings suggest that HIV-positive women who use opioids during pregnancy are more likely than HIV-negative women to also use alcohol and tobacco and have depression and sepsis. These results are consistent with others[21] that found opioid use during pregnancy to be more likely among women who smoked and used other illicit drugs in their second and/or third trimesters and were diagnosed as having a psychiatric condition, such as major depressive disorder and generalized anxiety disorder. Consistent with previous research, opioid use alone[7] and HIV-positive status alone[22] in pregnancy were found to have statistically significant associations with spontaneous abortions, any abortive pregnancy, and early-onset delivery. Considering that many of these negative maternal and fetal outcomes are preventable, our findings point to the importance of increased adherence to the recommended early universal screening, brief intervention, and referral to treatment for opioid use and opioid use disorder among all pregnant women.[23]

Despite the high rates of opioid use among HIV-positive pregnant women, the trends of opioid use in this population were stable during the study period. This trend stabilization could be a result of the effectiveness of national HIV intervention programs,[24] which target individuals who engage in high-risk behaviors such as drug use and unsafe sex practices. These programs focus on behavioral and biomedical intervention to prevent the transmission of HIV and HIV-related complications. The trend for HIV-negative pregnant women has an increasing prevalence of 13.2%/year, giving evidence to the rising opioid epidemic in the general population.

Even with its valuable findings, this study is not without limitations. One limitation was our inability to quantify viral loads or information on the use of highly active antiretroviral therapy among the HIV-positive pregnant women in the study population; thus, we were unable to examine the potential contribution these measures may have made to the risk of maternal–fetal complications among HIV-positive pregnant women in this study. In addition, given the cross-sectional, deidentified characteristic of the NIS database, it was not possible to identify repeat pregnancies and adjust for intracluster correlations for clustered pregnancies. Furthermore, we were not able to link pregnancy-related hospitalizations for each woman over time or link maternal encounters to birth/postbirth hospitalizations for any offspring. Such linkages may have allowed for a more in-depth evaluation of inpatient care during the pregnancy and incorporation of detailed information on birth outcomes. Lastly, there may have been underreporting or inaccuracies related to alcohol and other substance use in the discharge records, which may lead to misclassification bias. Despite these limitations, a major strength of this study includes its large sample size and statistical power. The population studied is representative of the national demographic component and therefore generalizable. Timeliness is another merit of this study, given the current opioid epidemic and the paucity of research studies focused on drug use among HIV-positive pregnant women.

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