ArticlePregnancy (Hoboken, N.J.)2026
Pregnancy and postpartum cannabis and alcohol use among people with HIV in the United States.
Article in Pregnancy (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate patterns of alcohol and cannabis use in pregnancy and postpartum and identify associated factors in a large, diverse cohort of people with HIV. Methods: We analyzed data on cannabis and alcohol use from the Surveillance Monitoring for ART Toxicities study, which enrolled pregnant people with HIV at 22 United States sites. We included participants who completed a questionnaire about substance use during pregnancy and postpartum between 2007 and 2019. Postpartum cannabis and alcohol use patterns were categorized as: (1) never (in pregnancy or postpartum), (2) initiation/resumption (no use in pregnancy, any use postpartum), (3) continuation (any use in pregnancy and postpartum), or (4) discontinuation (any use in pregnancy, no use postpartum). Multivariable log-binomial or Poisson models were fit using generalized estimating equations among pregnancies without use during pregnancy to determine factors associated with cannabis or alcohol initiation/resumption. Results: Among 1765 pregnancies with alcohol data, 8% reported alcohol use during pregnancy and 44% postpartum. Among 1772 pregnancies with cannabis data, cannabis use during pregnancy was also less frequent (8%) than postpartum (14%). The adjusted relative risk (aRR) of postpartum alcohol initiation/resumption was lower for each additional year of age (aRR, 0.98; 95% confidence interval [CI], 0.97, 0.99), for those with less annual household income (≤$10,000 vs. >$30,000; aRR, 0.77; CI, 0.65, 0.91), and for those with less than high school education (vs. greater; aRR, 0.84; CI, 0.72, 0.99). It was greater for those from a Midwest versus Northeast location (aRR, 1.44; CI, 1.16, 1.80), for participants with a cesarean birth (aRR, 1.14; CI, 1.01, 1.30), and for those who used tobacco during pregnancy (aRR, 1.19; CI, 1.00, 1.40). Factors associated with postpartum cannabis initiation/resumption included younger age (aRR, 0.94; CI, 0.91, 0.97), lower household income (aRR, 1.90; CI, 1.06, 3.40), more recent delivery year (aRR, 1.10 per year; CI, 1.02, 1.18), psychiatric diagnosis during pregnancy (aRR, 1.71; CI, 1.02, 2.86), and tobacco use during pregnancy (aRR, 1.94; CI, 1.29, 2.94). Conclusions: Risk factors differ for alcohol versus cannabis initiation or resumption after pregnancy among people with HIV. 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.
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