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

Abstract

BackgroundPregnancy 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.MethodsWe 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.ResultsOf 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).ConclusionNearly 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.

Factors affecting long acting and permanent contraceptive methods utilization among HIV positive married women attending care at ART clinics in Northwest Ethiopia

“…In this study, the disaggregated result on ART status noted that higher proportion of women who didn’t start ART (61.7%) had no more birth intention at all than women who were on ART (41.4%). This idea is also supported by different studies [ 28 – 30 ].…”

Codesigning care improvements for women living with HIV: a patient-oriented deliberative dialogue workshop in Montréal, Quebec

“…Research programming, 47,48 integrate women's health in HIV care 14,21 and increase supports for self-management 49 in a chronic disease era. The deliberative outputs also provide compelling endorsement of care improvement efforts already underway in Quebec.…”

“…9 Furthermore, reproductive discussions with providers remain scarce, 10,11 despite the importance of adopting strategies to prevent HIV transmission to sexual partners or infants, 12 the potential toxicity of ART on the fetus 13 and high rates of unplanned pregnancies. 14 Women also experience challenges engaging consistently in HIV care, [15][16][17] from HIV testing 18 to ART adherence 19 and sustained viral suppression. 20 Finally, women characterize their experience of HIV and women's health care as fragmented, influenced by care providers' lack of HIV knowledge and persistent HIV-related stigma.…”

Semi-parametric model for timing of first childbirth after HIV diagnosis among women of childbearing age in Ibadan, Nigeria

“…Meanwhile, a long duration on ART has been established to influence women's desire for children [7]. Even in the era of effective ART, empirical studies have established that HIV diagnosis may significantly influence women's decision and timing to have the next child birth or otherwise [8][9][10][11]. Child's birth may boost motherhood status among WLWH.…”