Date Published: July 20, 2017
Publisher: Public Library of Science
Author(s): Kate Salters, Mona Loutfy, Alexandra de Pokomandy, Deborah Money, Neora Pick, Lu Wang, Shahab Jabbari, Allison Carter, Kath Webster, Tracey Conway, Daniele Dubuc, Nadia O’Brien, Karene Proulx-Boucher, Angela Kaida, Ruanne V. Barnabas.
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.
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.
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).
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.
Health and survival outcomes for people living with HIV have improved dramatically since the advent of combination antiretroviral therapy (cART) [1–3]. HIV treatment with sustained viral suppression is also enabling safer reproductive options for women living with HIV (WLWH), including better maternal health, improved fertility , negligible risk of HIV transmission to partners during condomless sex [5–7], and dramatic reductions in perinatal HIV transmission risk [8–10]. These improvements have transformed the reproductive health landscape for people living with or affected by HIV [11–17], with studies demonstrating that WLWH are more likely to become pregnant and have children in the modern cART era than in earlier years of the HIV epidemic [18, 19].
Among women living with HIV in Canada, we found that approximately one in four women reported pregnancy after HIV diagnosis and that pregnancy was more frequent in the modern cART era and with uptake of cART. Pregnancy incidence rates observed in this study are lower than rates observed in other studies of WLWH in other global settings [11, 15, 49, 50], however is consistent with a lower pregnancy rate in the general Canadian population (54.6 per 1000 women) .