Association of Coexposure to Substance Exposures In Utero With Placental Pathology and Pregnancy Outcomes in Human Immunodeficiency Virus–Affected Pregnancies on Antiretroviral Therapy [ID 1051]

INTRODUCTION: Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) during pregnancy are associated with risk for adverse pregnancy outcomes. Substance use disorders (SUDs) are a common comorbidity among pregnant people with HIV, but the combined effects of HIV and SUD on pregnancy outcomes and placental health have yet to be explored. Our objective was to compare select pregnancy and placental health outcomes in pregnancies affected by HIV alone to those affected by concurrent HIV and SUD. METHODS: This retrospective cohort study compared select pregnancy outcomes, placental pathology, and placental efficiency score (defined as infant weight divided by placental weight) between pregnancies affected by HIV alone and those affected by concurrent HIV and SUD from one institution. RESULTS: There were 122 participants in the HIV-no-SUD group and 19 in the HIV-with-SUD group. Gestational age ( P =.01) and birth weight ( P =.002) were significantly lower in the HIV-with-SUD cohort (Table 2). Higher rates of premature rupture of membranes ( P =.005) and neonatal intensive care unit (NICU) admission ( P =.002) were also observed. In a linear regression model, those with HIV and SUD had a placental efficiency score that was 1.726 (95% CI, 4.07–6.71) lower ( P =.008) after adjusting for any ART, preeclampsia, and hepatitis C co-infection. CONCLUSIONS/IMPLICATIONS: Concurrent HIV and SUD were associated with higher risk for preterm birth, low birth weight, lower placental efficiency score, premature rupture of membranes, and NICU admission. These findings suggest that SUD in HIV-affected pregnancies increases the risk for adverse pregnancy outcomes and poorer placental health.