Study Finds Increased Marijuana Use During Pregnancy, Post Partum Among People With HIV

Marijuana use by people with HIV during pregnancy and post partum increased over time, with the prevalence of general substance use increasing more post partum.

Marijuana use by people with HIV during pregnancy and post partum increased over time and in states with legalized medical marijuana, a cohort study published in JAMA Network Open found.

The study also found that opioid and alcohol use during pregnancy did not change much, but are still happening at relatively high rates.

Researchers collected data from 2926 pregnancies among 2310 people living with HIV who were enrolled in the Surveillance Monitoring for Antiretroviral Toxicities (SMARTT) study, and the mean (SD) age was 28.8 (6.1) years.

Marijuana use during pregnancy increased from 7.1% in 2007-2008 to 11.7% in 2018-2019, with an overall prevalence of 9.3%. Additionally, prevalence peaked at 13.3% in 2013.

The prevalence of opioid and alcohol use during pregnancy, specifically, remained relatively stable, with the prevalence of opioid use decreasing from 5.8% in the first study period to 3.9% in the second study period, and alcohol use barely decreasing from 8.6% to 8.2% in that same time. However, both saw high prevalence in between the study periods, with opioid use peaking at 8.7% in 2012 and alcohol use peaking at 11.8% in 2013. Concomitant alcohol and marijuana use was also generally low and stable, increasing from 1.8% to 2.8%, but again saw a high peak with 5.2% in 2014.

Overall postpartum substance use was more common across the board, with a mean prevalence of 44.4% for alcohol, 13.6% for marijuana, and 10.0% for concomitant alcohol and marijuana.

The prevalence of marijuana use during the postpartum period increased more dramatically, from 10.2% to 23.7%. Postpartum alcohol use also increased from 36.2% in 2007-2008 to 53.8% in 2012, but dropped back down to 42.1% in 2018-2019. Concomitant postpartum alcohol and marijuana use, like during pregnancy, had generally lower prevalence, but still increased from 6.7% to 15.8% between the first and last study periods.

More specifically, substance use overall was most common in the first trimester of pregnancies and in the postpartum period. Consistent with other studies, these data indicate that substance use prevalence decreases with advancing gestation, potentially because of alleviation of nausea or awareness of pregnancy.

“These patterns of increasing marijuana use among pregnant and postpartum people living with HIV suggest that enhanced clinical attention is warranted, given the potential maternal and child health implications of substance use,” the study authors said.

According to the authors, the adjusted mean risk of marijuana use increased by 7% (95% CI, 3%-10%) per year during pregnancy and 11% (95% CI, 7%-16%) per year post partum, and postpartum concomitant alcohol and marijuana use increased by 10% (95% CI, 5%-15%) per year.

They also found that differences in substance use prevalence were not associated with recreational legalization, but marijuana use was associated with medical marijuana legalization.

“Marijuana use was higher among persons living in states and during periods with medical marijuana legalization,” the authors said. “Understanding how the opioid crisis and evolving legal policies on marijuana are associated with substance use among pregnant and postpartum people living with HIV has important public health implications for pregnancy- and HIV-related health.”

A previous analysis of SMARTT data showed that overall substance use rates decreased sharply from 1990 to 2012 in pregnant people living with HIV; however, substance use was defined more broadly in that analysis. The authors also cite the current opioid epidemic and changes in marijuana legalization as major potential factors for the increased prevalence rates of substance use among pregnant and postpartum people living with HIV.

“In addition, the potential association of marijuana use with adherence to antiretroviral therapy must be considered,” the authors said. They added that, “although marijuana may be favorably associated with adherence if it alleviates nausea, for example, the potential deleterious associations of substance use with regard to perinatal HIV transmission represent important aspects of counseling.”


Yee LM, Kacanek D, Brightwell C, et al. Marijuana, opioid, and alcohol use among pregnant and postpartum individuals living with HIV in the US. JAMA Netw Open. Published online December 3, 2021. doi:10.1001/jamanetworkopen.2021.37162