Only a fifth of
pregnancies among women living with HIV in the United States are planned, research
published in the online edition of the Journal
of Acquired Immune Deficiency Syndromes shows. The majority of women were
ambivalent about their pregnancy and planned pregnancies were associated with
patient-initiated discussions about conception and pregnancy.
suggest that family planning – including discussions of effective
contraception, pregnancy intentions and safer contraception methods – alongside
HIV prevention education – is needed in this population…in the primary HIV
care setting,” comment the authors. “Our goal should be to maximize the number
of planned pregnancies.”
HIV treatment and care mean that the risk of vertical (mother-to-child) transmission of
HIV can be reduced to below 1%. Moreover, use of antiretroviral therapy can
minimise the risk of sexual transmission of HIV in couples wishing to conceive.
The number of
pregnancies among women living with HIV in the US increased by 30% between 2000
and 2006. However, relatively little is known about pregnancy planning among
women in the US. Investigators from the HIV and Obstetrics Pregnancy Education
Study (HOPES) therefore designed a cross-sectional study involving women with HIV who received care at twelve sites in 2012.
All the women knew
they were living with HIV before becoming pregnant and were aged 18 or over.
They completed the
London Measure of Unplanned Pregnancy (LMUP), a validated questionnaire
designed to assess the pregnancy intentions of women who are already pregnant. The
LMUP categorises pregnancies as unplanned, ambivalent pregnancy or planned. The
women were also asked about their engagement with HIV care in the year before
they became pregnant and if they had had any discussions with a healthcare
provider about conception and pregnancy.
A total of 172
women were recruited to the study. Their median age was 28 years and 78% were
black. The majority (86%) reported that they had seen a healthcare provider in
the year before their pregnancy, including 77% who had seen an HIV specialist
and 47% who had received interdisciplinary care (combination of HIV care,
primary care and/or obstetrics and gynaecology). Most (81%) were taking
antiretroviral therapy in the year before conceiving.
(45%) of participants reported that they had initiated a conversation with a
healthcare provider about their interest in pregnancy and 60% said that a
healthcare provider had raised this subject with them. Conversations with
healthcare staff about conception and birth control were reported by 81% of
women and 97% said they had been informed about condom use to prevent the
transmission of HIV and sexually transmitted infections.
Analysis of the
LMUP scores showed that 19% of participants had planned their pregnancy, 58%
were ambivalent and 23% had an unplanned pregnancy. Over half (52%) indicated
that they had not intended to become pregnant and a similar proportion (54%)
stated that when they became pregnant they did not want the baby.
with a reduced risk of an unplanned or ambivalent pregnancy included a previous
pregnancy since diagnosis with HIV (aRR = 0.67; 95% CI, 0.47-0.94, p = 0.02).
“We speculate that
this may be related to increased knowledge regarding the low risk of
transmission of HIV during pregnancy from past experience and, therefore, less
ambivalence or fear regarding planning for a future pregnancy,” comment the
Having seen a
healthcare provider (aRR = 0.60; 95% CI, 0.46-0.77, p < 0.001) and having a
patient-initiated pregnancy discussion (aRR = 0.63; 95% CI, 0.46-0.77, p <
0.001) also significantly reduced the risk of unwanted or ambivalent
conclude that interventions that increase the engagement of women
living with HIV with health care and the incorporation of pregnancy discussions and counselling
into routine HIV care may decrease rates of unplanned or ambivalent pregnancies
among women with HIV.