Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada

PLoS One. 2017 Jul 20;12(7):e0180524. doi: 10.1371/journal.pone.0180524. eCollection 2017.

Abstract

Background: Pregnancy incidence rates among women living with HIV (WLWH) have increased over time due to longer life expectancy, improved health status, and improved access to and HIV prevention benefits of combination antiretroviral therapy (cART). However, it is unclear whether intended or unintended pregnancies are contributing to observed increases.

Methods: We analyzed retrospective data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Kaplan-Meier methods and GEE Poisson models were used to measure cumulative incidence and incidence rate of pregnancy after HIV diagnosis overall, and by pregnancy intention. We used multivariable logistic regression models to examine independent correlates of unintended pregnancy among the most recent/current pregnancy.

Results: Of 1,165 WLWH included in this analysis, 278 (23.9%) women reported 492 pregnancies after HIV diagnosis, 60.8% of which were unintended. Unintended pregnancy incidence (24.6 per 1,000 Women-Years (WYs); 95% CI: 21.0, 28.7) was higher than intended pregnancy incidence (16.6 per 1,000 WYs; 95% CI: 13.8, 20.1) (Rate Ratio: 1.5, 95% CI: 1.2-1.8). Pregnancy incidence among WLWH who initiated cART before or during pregnancy (29.1 per 1000 WYs with 95% CI: 25.1, 33.8) was higher than among WLWH not on cART during pregnancy (11.9 per 1000 WYs; 95% CI: 9.5, 14.9) (Rate Ratio: 2.4, 95% CI: 2.0-3.0). Women with current or recent unintended pregnancy (vs. intended pregnancy) had higher adjusted odds of being single (AOR: 1.94; 95% CI: 1.10, 3.42), younger at time of conception (AOR: 0.95 per year increase, 95% CI: 0.90, 0.99), and being born in Canada (AOR: 2.76, 95% CI: 1.55, 4.92).

Conclusion: Nearly one-quarter of women reported pregnancy after HIV diagnosis, with 61% of all pregnancies reported as unintended. Integrated HIV and reproductive health care programming is required to better support WLWH to optimize pregnancy planning and outcomes and to prevent unintended pregnancy.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Canada
  • Family Planning Services
  • Female
  • HIV Seropositivity / diagnosis*
  • HIV Seropositivity / drug therapy
  • HIV Seropositivity / epidemiology
  • Humans
  • Incidence
  • Intention*
  • Pregnancy
  • Pregnancy Rate
  • Pregnancy, Unplanned*
  • Sexual Behavior*
  • Women's Health*
  • Young Adult

Substances

  • Anti-HIV Agents

Grants and funding

CHIWOS is funded by the Canadian Institutes of Health Research (CIHR, MOP111041); the CIHR Canadian HIV Trials Network (CTN 262); the Ontario HIV Treatment Network (OHTN); and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. KS and AC received doctoral scholarship support from the Canadian Institutes of Health Research (CIHR). AdP received support from Fonds de Recherche du Quebéc – Santé (FRQS) (Chercheur-boursier clinicien – Junior. NO received support from FRQS. AK received salary support through a Tier 2 Canada Research Chair in Global Perspectives on HIV and Sexual and Reproductive Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.