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 unintend...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5519029?pdf=render |
| _version_ | 1818030943276892160 |
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| author | 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 CHIWOS Research Team |
| author_facet | 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 CHIWOS Research Team |
| author_sort | Kate Salters |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-10T05:43:37Z |
| format | Article |
| id | doaj.art-b0d6ccce4b064dbe85a7ddbc2625299d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-10T05:43:37Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-b0d6ccce4b064dbe85a7ddbc2625299d2022-12-22T02:00:13ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01127e018052410.1371/journal.pone.0180524Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada.Kate SaltersMona LoutfyAlexandra de PokomandyDeborah MoneyNeora PickLu WangShahab JabbariAllison CarterKath WebsterTracey ConwayDaniele DubucNadia O'BrienKarene Proulx-BoucherAngela KaidaCHIWOS Research TeamBACKGROUND: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.http://europepmc.org/articles/PMC5519029?pdf=render |
| spellingShingle | 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 CHIWOS Research Team Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada. PLoS ONE |
| 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 |
| url | http://europepmc.org/articles/PMC5519029?pdf=render |
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