Substance abuse and HIV in pregnancy

Substance abuse is a significant risk factor for HIV in pregnancy. Most substances can have deleterious effects on perinatal outcome, and in pregnancies complicated by maternal HIV infection, substance abuse may contribute to the rate of vertical transmission and the progression of maternal disease. Therefore, pregnant substance-abusing women should be identified and targeted for HIV counseling and testing. In addition, drug rehabilitation should be strongly advocated. In populations with high prevalences of substance abuse and HIV infection, exceptional measures such as voluntary routine drug screening and needle exchange programs at the site of prenatal care may be considered. Future research is required to understand the relationship among the type, severity, and stage of drug addiction and the difference in risk-taking behavior as it relates to HIV transmission. Intervention studies must be designed, implemented, and evaluated to identify the most effective strategy for managing pregnant substance abusers who are exposed or at risk of exposure to HIV.