Date Published: February 6, 2019
Publisher: Public Library of Science
Author(s): Clara E. Van Ommen, Arianne Y. K. Albert, Micah Piske, Deborah M. Money, Hélène C. F. Cote, Viviane D. Lima, Evelyn J. Maan, Ariane Alimenti, Julianne van Schalkwyk, Neora Pick, Melanie C. M. Murray, Justyna Dominika Kowalska.
To evaluate the birth rates of women living with HIV (WLWH) compared to the general population in British Columbia (BC), Canada.
We retrospectively reviewed clinical and population level surveillance data from 1997 to 2015. Live birth rates from 1997 to 2015 among WLWH aged 15–49 years were compared with those of all BC women. Next, the number of live births among WLWH with a live birth between 1997–2012 and HIV-negative controls matched 1:3 by geocode were compared.
WLWH had a lower birth rate compared to all BC women [31.4 (95%CI, 28.6–34.3) vs. 40.0 (39.3–40.1)/1000 person years]. Stratified by age, WLWH aged 15–24 years had a higher birth rate while WLWH aged 25–49 years had a lower birth rate than BC women (p<0.01). Between 1997 and 2015, birth rates for both populations decreased among women aged 15–24 years, and increased among women aged 25–49 years, most strikingly among WLWH 35–49 years (p<0.01). When comparing WLWH with a live birth to HIV-negative geocode matched controls, WLWH aged 15–24 years (p = 0.03) and aged 25–34 years (p<0.01) had more live births than controls while WLWH aged 35–49 years did not (p = 0.06). On a population level, WLWH have lower birth rates than the general population. However, this is not observed among WLWH who have ever given birth compared with matched controls, suggesting that sociodemographic factors may play an important role. WLWH are increasingly giving birth in their later reproductive years. Taken together, our data supports the integration of reproductive health and HIV care.
In Canada, the majority of women living with HIV (WLWH) are of reproductive age (15–49 years) . Recent studies have found that most WLWH desire or intend to become pregnant in the future, and indicate that motherhood is important to them [2–5]. Given that many WLWH desire pregnancy, it is important to understand the impact of HIV on the birth rates and reproductive outcomes of WLWH.
Our study shows that in an era of good access to effective cART, WLWH in BC still experience an overall birth rate lower than the general population. These results align with other studies examining the live birth rates of WLWH. A study of WLWH aged 15–49 in Ontario observed a live birth rate of 35.3 vs. 44.4 per 1000 woman years in the general Ontario population from 2002–2010 . These Ontario birth rates reported for WLWH and the general population were both higher than those observed in our BC study. This may be related to differences in the ethnic origins and sociodemographic makeup of WLWH in these two provinces. Ontario has a larger proportion of the population with ancestry in Africa and the Caribbean than BC does . Indeed the Ontario study reported a higher birth rate among WLWH with African or Caribbean origins compared to others . In contrast, a recent study on the birth rates of WLWH in the United States found significantly lower birth rates among WLWH compared to HIV-negative women at high risk for HIV acquisition from 1994–2001, but no difference during the 2002–2012 period. This latter observation may be at least partially explained by the fact that the control population for this study consisted of high-risk HIV-negative women in whom substance use and/or increased illness burden may decrease birth rates relative to the general population .
In conclusion, we observed that, as a group, WLWH experience a lower birth rate than the general population, but when sociodemographically matched this difference did not persist suggesting this is not a biologic phenomenon but likely related to social circumstances. Of note, on a population level, WLWH are increasingly likely to bear children later in life, something that has implications for the care of WLWH and their reproductive planning. The results of this study are an important step toward further understanding the reproductive health trends of WLWH, especially now that WLWH can have pregnancies with little or no risk of vertically transmitting HIV to their child if engaged in care and appropriately treated. This study provides additional evidence that the care of WLWH who are within their reproductive years must include appropriate reproductive care alongside their HIV care, and counselling to explore their pregnancy plans and desires. Ultimately, this supports the need to integrate reproductive health care into a comprehensive HIV care program for every woman living with HIV and ensure pregnancy planning is included in HIV care .