Pregnancy Intentions Among Women Living With HIV in the United States

• Type of Material: Article
• Authors: Lisa Rahangdale, University of North Carolina; Amanda Stewart, Johns Hopkins University; Robert D. Stewart, University of Texas Southwestern; Martina Badell, Emory University; Judy Levison, Baylor College of Medicine; Pamala Ellis, Women's Hospital; Susan E. Cohn, Northwestern University; Miriam-Colette Kempf, University of Alabama Birmingham; Gweneth B. Lazenby, Medical University of South Carolina; Richa Tandon, Boston Medical Center; Aadia Rana, Brown University; Minh Ly T Nguyen, Emory University; Marcia S. Sturdevant, University of Alabama Birmingham; Deborah Cohan, University of California, San Francisco
• Language: English
• Date: 2014-03-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2013 by Lippincott Williams & Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000000014
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 65
• Issue: 3
• Start Page: 306
• End Page: 311
• Grant/Funding Information: This research was funded in its entirety by a 2010 developmental grant from the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR), an NIH funded program P30 AI50410.
• Keywords: HIV; Immunology; PREVENTION; DISPARITIES; HEALTH; CLINICAL CARE; TRANSMISSION; PREEXPOSURE PROPHYLAXIS; Science & Technology; INFECTED WOMEN; pregnancy intention; INTERVENTIONS; pregnancy; Infectious Diseases; serodifferent; serodiscordant; RATES; Life Sciences & Biomedicine

Abstract

BACKGROUND:: The number of HIV-infected women giving birth in the United States is increasing. Research on pregnancy planning in HIV-infected women is limited. METHODS:: Between January 1 and December 30, 2012, pregnant women with a known HIV diagnosis before conception at 12 US urban medical centers completed a survey including the London Measure of Unplanned Pregnancy (LMUP) scale. We assessed predictors of LMUP category (unplanned/ambivalent versus planned pregnancy) using bivariate and multivariable analyses. RESULTS:: Overall, 172 women met inclusion criteria and completed a survey. Based on self-report using the LMUP scale, 23% women had an unplanned pregnancy, 58% were ambivalent, and 19% reported a planned pregnancy. Women were at lower risk for an unplanned or ambivalent pregnancy if they had previously given birth since their HIV diagnosis [adjusted relative risk (aRR) = 0.67, 95% confidence interval (CI): 0.47 to 0.94, P = 0.02], had seen a medical provider in the year before the index pregnancy (aRR = 0.60, 95% CI: 0.46 to 0.77, P < 0.01), or had a patient-initiated discussion of pregnancy intentions in the year before the index pregnancy (aRR = 0.63, 95% CI: 0.46 to 0.77, P < 0.01). Unplanned or ambivalent pregnancy was not associated with age, race/ethnicity, or educational level. CONCLUSIONS:: In this multisite US cohort, patient-initiated pregnancy counseling and being engaged in medical care before pregnancy were associated with a decreased probability of unplanned or ambivalent pregnancy. Interventions that promote healthcare engagement among HIV-infected women and integrate contraception and preconception counseling into routine HIV care may decrease the risk of unplanned pregnancy among HIV-infected women in the United States.