Prevalence and outcomes of pregnancies in women with HIV over a 20-year period

Kowalska, Justyna D.; Pelchen–Matthews, Annegret; Ryom, Lene; Losso, Marcelo; Trofimova, Tatiana; Mitsura, V. M.; Khromova, Irina; Paduta, Dzmitry; Stephan, Christoph; Domingo, Peré; Bąkowska, Elżbieta; Monforte, Antonella d’Arminio; Oestergaard, Lars; Jabłonowska, Elżbieta; Kuznetsova, Anastasiia; Moreno, Santiago; Vasylyev, Marta; Pradier, Christian; Battegay, Manuel; Vandekerckhove, Linos; Castagna, Antonella; Raben, Dorthe; Mocroft, Amanda

doi:10.1097/qad.0000000000002954

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…Data on behavioural factors (diet, exercise, level of alcohol consumption) were not collected in EuroSIDA. Data on pregnancies [37], thyroid disease, substance use, depression and psychiatric illness including use of antidepressants and antipsychotics were collected inconsistently over time and between clinics.…”

Section: Discussionmentioning

confidence: 99%

Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens

Mast

Wit

Gerstoft

et al. 2022

Aids

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Background: Weight gain is becoming increasingly prevalent amongst people with HIV (PWH) receiving contemporary antiretroviral treatment. We investigated BMI changes and clinical impact in a large prospective observational study.Methods: PWH aged !18 years were included who started a new antiretroviral (baseline) during 2010-2019 with baseline and !1 follow-up BMI assessment available. Rates of clinical outcomes (cardiovascular disease [CVD], malignancies, diabetes mellitus [DM] and all-cause mortality) were analysed using Poisson regression to assess effect of time-updated BMI changes (>1 kg/m 2 decrease, AE1 kg/m 2 stable, >1 kg/m 2 increase), lagged by 1-year to reduce reverse causality. Analyses were adjusted for baseline BMI plus key confounders including antiretroviral exposure.Results: 6721 PWH were included; 72.3% were male, median age 48 years (interquartile range [IQR] 40-55). At baseline, 8.4% were antiretroviral-naive, and 5.0% were underweight, 59.7% healthy weight, 27.5% overweight, and 7.8% were living with obesity. There was an 8.2% increase in proportion of overweight and 4.8% in obesity over the study period (median follow-up 4.4 years ).

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Section: Discussionmentioning

confidence: 99%

Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens

Mast

Wit

Gerstoft

et al. 2022

Aids

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“…Contrary to our findings, Haddad et al 6 , in a study conducted in 9 U.S. centers, reported a non-significant increase in pregnancy incidence in WLWHA and a significant increase in live births (from 2.85 to 7.27/100 person-years) in the periods 1994-1997 to 2006-2012, with similar values in WLWHA and in women not living with HIV/AIDS (WNLWHA) in more recent periods. Studies in Canada 7 and Europe 22 also report an increased number of pregnancies in WLWHA after the years 2000-2002. One study in Burkina-Faso 20 showed an increase in pregnancy incidence in women using ART for longer periods.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy incidence, outcomes and associated factors in a cohort of women living with HIV/AIDS in Rio de Janeiro, Brazil, 1996-2016

et al. 2023

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The aim of this research was to analyze pregnancy incidence and associated factors in a cohort of 753 women living with HIV/AIDS (WLWHA) in Rio de Janeiro, Brazil, from 1996 to 2016. Women aged 18-49 years who were not on menopause (surgical or natural) and did not have a tubal ligation were eligible for the study. Data were collected by medical professionals during initial and follow-up visits. Person-time pregnancy incidence rates were calculated throughout the follow-up period. Pregnancy incidence-associated factors were investigated by univariate and multiple analyzes, using an extension of the Cox survival model. Follow-up visits recorded 194 pregnancies, with an incidence rate of 4.01/100 person-years (95% CI: 3.47; 4.60). A higher pregnancy incidence was associated with CD4 nadir ≥ 350 cells/mm³, use of an antiretroviral regimen not containing Efavirenz, and prior teenage pregnancy. In turn, women with a viral load ≥ 50 copies/mL, age ≥ 35 years old, with two or more children and using a highly effective contraceptive method showed a lower incidence. Results showed a significant reduction in pregnancy incidence after 2006, a significant reduction in female sterilization from 1996 to 2016, and a high rate of cesarean sections. The association found between pregnancy incidence and the use of contraceptive methods and virological control markers suggests a good integration between HIV/AIDS and reproductive health services. The high rate of cesarean section delivery indicates the need to improve childbirth care.

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“…Although over 80% of the nearly 50,000 women newly diagnosed with HIV in Europe in 2018 were fertile-aged [ 8 ], little is known about the rates and risk factors for induced abortions among women living with HIV (WLWH). Most data come from limited questionnaire studies with varying response rates [ 9 – 11 ]. In questionnaire studies on the general population, induced abortions have been significantly underreported [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Induced abortions of women living with HIV in Finland 1987–2019: a national register study

Mutru

Kivelä

Ollgren

et al. 2023

BMC Pregnancy Childbirth

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Background Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987–2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented. Methods A retrospective nationwide register study of all WLWH in Finland 1987–2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland. Results Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987–1997 to 2009–2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998–2019 were being foreign-born (OR 3.09, 95% CI 1.55–6.19), younger age (OR 0.95 per year, 95% CI 0.90–1.00), previous induced abortions (OR 3.36, 95% CI 1.80–6.28), and previous deliveries (OR 2.13, 95% CI 1.08–4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008–0.029%. Conclusions Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.

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Prevalence and outcomes of pregnancies in women with HIV over a 20-year period

Cited by 5 publications

References 23 publications

Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens

Changes in body mass index and clinical outcomes after initiation of contemporary antiretroviral regimens

Pregnancy incidence, outcomes and associated factors in a cohort of women living with HIV/AIDS in Rio de Janeiro, Brazil, 1996-2016

Induced abortions of women living with HIV in Finland 1987–2019: a national register study

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