Original Article

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

Authors: 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

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.
Posted in: Infectious Disease146 Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV) Infection21 Pregnancy34

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. National Institute on Drug Abuse. Opioid overdose crisis. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Accessed October 24, 2018.
2. US Department of Health and Human Services. About the epidemic. https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed October 24, 2018.
3. National Association of County and City Health Officials. Opioid overdose epidemic. https://www.naccho.org/programs/community-health/injury-and-violence/opioid-epidemic. Accessed October 25, 2018.
4. Health Resources and Services Administration. Opioid crisis. https://www.hrsa.gov/opioids. Accessed October 25, 2018.
5. Patrick SW, Davis MM, Lehmann CU, et al. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015;35:650-655.
6. Patrick SW, Schumacher RE, Benneyworth BD, et al. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012;307:1934-1940.
7. Whiteman VE, Salemi JL, Mogos MF, et al. Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy 2014;2014:906723.
8. Salihu HM, Salemi JL, Aggarwal A, et al. Opioid drug use and acute cardiac events among pregnant women in the United States. Am J Med 2018;131:64-71.e1.
9. Yazdy MM, Mitchell AA, Tinker SC, et al. Periconceptional use of opioids and the risk of neural tube defects. Obstet Gynecol 2013;122:838-844.
10. Broussard CS, Rasmussen SA, Reefhuis J, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol 2011;204:314.e1-e11.
11. Hudak ML, Tan RC, The Committee on Drugs.et al. Neonatal drug withdrawal. Pediatrics 2012;129:e540-e560.
12. Wexelblatt SL, McAllister JM, Nathan AT, et al. Opioid neonatal abstinence syndrome: an overview. Clin Pharmacol Ther 2018;103:979-981.
13. Wejnert C, Hess KL, Hall HI, et al. Vital signs: trends in HIV diagnoses, risk behaviors, and prevention among persons who inject drugs-United States. MMWR Morb Mortal Wkly Rep 2016;65:1336-1342.
14. Centers for Disease Control and Prevention. HIV surveillance report, 2015 vol. 27. November 2016 https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf. Accessed November 14, 2018.
15. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. HIV surveillance report, volume 28: diagnoses of HIV Infection in the United States and Dependent Areas, 2016. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf. Published 2017. Accessed November 14, 2018.
16. Centers for Disease Control and Prevention. HIV and pregnant women, infants, and children. https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html. Accessed November 14, 2018.
17. Healthcare Cost and Utilization Project. Introduction to the HCUP Nationwide Inpatient Sample (NIS), 2011. http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2011.pdf. Updated November 2015. Accessed January 1, 2016.
18. Health Care Cost and Utilization Project (HCUP). Introduction to the HCUP KIDS' Inpatient Database (KID), 2012. https://www.hcup-us.ahrq.gov/db/nation/kid/KID_2012_Introduction.pdf. Updated November 2015. Accessed January 1, 2017.
19. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335-351.
20. National Cancer Institute. Joinpoint trend analysis software. Regression Program, Version 4.2.0.2, Statistical Methodology and Applications Branch, Surveillance Research Program. http://surveillance.cancer.gov/joinpoint. Accessed January 4, 2015.
21. Smith MV, Costello D, Yonkers KA. Clinical correlates of prescription opioid analgesic use in pregnancy. Matern Child Health J 2015;19:548-556.
22. Xiao P-L, Zhou Y-B, Chen Y, et al. Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth 2015;15:246.
23. Committee on Obstetric Practice. Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstet Gynecol 2017;130:e81-e94.
24. Centers for Disease Control and Prevention. HIV: effective interventions. https://effectiveinterventions.cdc.gov. Accessed November 14, 2018.
25. MacDorman MF, Declercq E, Cabral H, et al. Recent increases in the U.S. maternal mortality rate: disentangling trends from measurement issues. Obstet Gynecol 2016;128:447-455.