575 - In-utero exposure to substance use in pregnant people living with HIV is associated with adverse pregnancy outcomes and poor placental health

Publication Number: 575.5140

Elisha M. Wachman, Boston University School of Medicine, Boston, MA, United States; Julia D. Glace, Boston University School of Medicine, Boston, MA, United States; Annie Johnson, Boston University School of Medicine, Boston, MA, United States; Noor A K. Chadha, Boston University School of Medicine, Boston, MA, United States; Sorraya Jaiprasert, Boston Medical Center, Waltham, MA, United States; Elizabeth Taglauer, Boston University School of Medicine, Boston, MA, United States; Elijah Paintsil, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Naima Joseph, Boston University School of Medicine, Boston, MA, United States

Background: HIV and antiretroviral therapy (ART) during pregnancy are associated with risk for alterations in placental pathology, and adverse pregnancy outcomes such as preterm delivery and fetal growth restriction. Substance use disorders (SUDs) are a common comorbidity amongst pregnant people with HIV, but the combined effects of HIV and substance exposure during the pregnancy on placental pathology and pregnancy outcomes have yet to be explored.

Objective: Our objective was to compare placental pathology and pregnancy outcomes in pregnancies affected by HIV alone to those affected by concurrent HIV and SUD.

Design/Methods: This retrospective cohort study identified pregnancies affected by HIV alone and those affected by concurrent HIV and SUD from one institution delivered between 2015-2023. Demographics, pregnancy outcomes, placental efficiency scores (infant weight divided by placental weight), and placental pathology were compared between pregnancies affected by HIV alone and those affected by concurrent HIV and SUD.

Results: There were 122 in the HIV alone and 19 in the HIV with SUD group. Ninety-five percent (n=133) were on ART by delivery. The most common prenatal substance exposures were nicotine, opioids, and cocaine. Those with HIV and SUD were most likely to identify as White (42.1% vs 4.1%) and to have Hepatitis C virus co-infection (55.6% vs 3.3%), and less likely to be on any ART at delivery (76.5% vs 97.5%).(Table 1). The mean gestational age [36.0 (standard deviation, 5.2) vs 38.7 (1.8) weeks], infant birth weight [2468 (953) vs 3097 (607) grams] was lower in the HIV and SUD exposed cohort when compared to the HIV alone group alone. Significant differences in pregnancy outcomes were noted between the cohorts with the HIV and SUD group having higher rates of premature rupture of membranes and NICU admission, and lower rates of pregnancy-induced hypertension and pre-eclampsia than the HIV alone group. (Table 2) In a linear regression model adjusted for any ART, pre-eclampsia, and Hepatitis C, those with HIV and SUD had a placental efficiency score that was lower [5.7 (SD 1.4) vs 7.4 (SD 1.8); adjusted mean difference 1.7 (95% CI 4.1-6.7)]. There were no significant differences in placental pathology diagnoses.(Table 3)

Conclusion(s): Concurrent HIV and SUD during pregnancy were associated with a higher risk for preterm birth, low birthweight, lower placental efficiency scores, premature rupture of membranes, and NICU admission in comparison to HIV alone. These findings suggest that SUD in HIV-affected pregnancies increases the risk for adverse pregnancy outcomes and poorer placental health.

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