title: Dramatic decline in substance use by HIV-infected pregnant women in the United States from 1990 to 2012.
abstract: OBJECTIVE
  We aimed to describe temporal changes in substance use among HIV-infected pregnant women in the United States from 1990 to 2012.
  
  
  METHODS
  Data came from two prospective cohort studies (Women and Infants Transmission Study and Surveillance Monitoring for Antiretroviral Therapy Toxicities Study).
  
  
  METHODS
  Women were classified as using a substance during pregnancy if they self-reported use or had a positive biological sample. To account for correlation between repeated pregnancies by the same woman, generalized estimating equation models were used to test for temporal trends and evaluate predictors of substance use.
  
  
  RESULTS
  Over the 23-year period, substance use among the 5451 HIV-infected pregnant women sharply declined; 82% of women reported substance use during pregnancy in 1990, compared with 23% in 2012. Use of each substance decreased significantly (P < 0.001 for each substance) in an approximately linear fashion, until reaching a plateau in 2006. Multivariable models showed substance use was inversely associated with receiving antiretroviral therapy. Among the subset of 824 women with multiple pregnancies under observation, women who used a substance in their previous pregnancy were at elevated risk of substance use during their next pregnancy (risk ratio, 5.71; 95% confidence interval, 4.63-7.05).
  
  
  CONCLUSIONS
  A substantial decrease in substance use during pregnancy was observed between 1990 and 2012 in two large US cohorts of HIV-infected women. Substance use prevalence in these cohorts became similar to that of pregnant women in the general US population by the mid-2000s, suggesting that the observed decrease may be due to an epidemiological transition of the HIV epidemic among women in the United States.
authors.affiliation: aDepartment of Epidemiology bCenter for Biostatistics and AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA cDepartment of Epidemiology, Biostatistics, and Occupational Health, McGill School of Medicine, Montreal, Quebec, Canada dDepartment of Pediatrics, Lurie Children's Hospital eDepartment of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rough
authors.forename: Katherine
authors.initials: K
authors.lastname: Tassiopoulos
authors.forename: Deborah
authors.initials: D
authors.lastname: Kacanek
authors.forename: Raymond
authors.initials: R
authors.lastname: Griner
authors.forename: Ram
authors.initials: R
authors.lastname: Yogev
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Rich
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult