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

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 uninten...

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Autores principales: Salters, Kate, Loutfy, Mona, de Pokomandy, Alexandra, Money, Deborah, Pick, Neora, Wang, Lu, Jabbari, Shahab, Carter, Allison, Webster, Kath, Conway, Tracey, Dubuc, Daniele, O’Brien, Nadia, Proulx-Boucher, Karene, Kaida, Angela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519029/
https://www.ncbi.nlm.nih.gov/pubmed/28727731
http://dx.doi.org/10.1371/journal.pone.0180524
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author Salters, Kate
Loutfy, Mona
de Pokomandy, Alexandra
Money, Deborah
Pick, Neora
Wang, Lu
Jabbari, Shahab
Carter, Allison
Webster, Kath
Conway, Tracey
Dubuc, Daniele
O’Brien, Nadia
Proulx-Boucher, Karene
Kaida, Angela
author_facet Salters, Kate
Loutfy, Mona
de Pokomandy, Alexandra
Money, Deborah
Pick, Neora
Wang, Lu
Jabbari, Shahab
Carter, Allison
Webster, Kath
Conway, Tracey
Dubuc, Daniele
O’Brien, Nadia
Proulx-Boucher, Karene
Kaida, Angela
author_sort Salters, Kate
collection PubMed
description 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.
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spelling pubmed-55190292017-08-07 Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada Salters, Kate Loutfy, Mona de Pokomandy, Alexandra Money, Deborah Pick, Neora Wang, Lu Jabbari, Shahab Carter, Allison Webster, Kath Conway, Tracey Dubuc, Daniele O’Brien, Nadia Proulx-Boucher, Karene Kaida, Angela PLoS One Research Article 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. Public Library of Science 2017-07-20 /pmc/articles/PMC5519029/ /pubmed/28727731 http://dx.doi.org/10.1371/journal.pone.0180524 Text en © 2017 Salters et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Salters, Kate
Loutfy, Mona
de Pokomandy, Alexandra
Money, Deborah
Pick, Neora
Wang, Lu
Jabbari, Shahab
Carter, Allison
Webster, Kath
Conway, Tracey
Dubuc, Daniele
O’Brien, Nadia
Proulx-Boucher, Karene
Kaida, Angela
Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada
title Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada
title_full Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada
title_fullStr Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada
title_full_unstemmed Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada
title_short Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada
title_sort pregnancy incidence and intention after hiv diagnosis among women living with hiv in canada
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519029/
https://www.ncbi.nlm.nih.gov/pubmed/28727731
http://dx.doi.org/10.1371/journal.pone.0180524
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