Pregnancy Intentions Among Women Living With HIV in the United States

Abstract

Background The number of HIV-infected women giving birth in the U.S. 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 prior to conception at 12 U.S. 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% of 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 = 0.67, 95% CI 0.47-0.94, p=0.02), had seen a medical provider in the year before the index pregnancy (aRR 0.60, 95% CI 0.46-0.77, p<0.01), or had a patient-initiated discussion of pregnancy intentions in the year prior to the index pregnancy (aRR = 0.63, 95% CI 0.46-0.77, p<0.01). Unplanned or ambivalent pregnancy was not associated with age, race/ethnicity, or educational level. Conclusions In this multi-site U.S. cohort, patient-initiated pregnancy counseling as well as being engaged in medical care prior to pregnancy were associated with a decreased probability of unplanned or ambivalent pregnancy. Interventions that promote health-care 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 U.S.

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

“…Although there has been increased access to ART, studies examining sexuality and reproduction for women living with HIV still show that HIV impacts sexuality and reproduction negatively (Carter et al, 2017a; Greene, Ion, Kwaramba, Smith, & Loutfy, 2015; Rahangdale et al, 2014). Women with HIV therefore face unique challenges, such as in partner relationships, sexual satisfaction and childbearing (Bharat & Mahendra, 2007; Carter et al, 2013; Florence et al, 2004).…”

Providers’ perspectives on preconception counseling and safer conception for HIV-infected women

“…However, among HIV-infected women who were either thinking about becoming pregnant, pregnant at the time surveyed, or pregnant in the past, 57% had not received preconception counseling (PCC; Squires et al, 2011). In a recent study of pregnant women living with HIV, 33% had not prepared for pregnancy by seeking medical advice, taking prenatal vitamins, or decreasing substance use (Rahangdale et al, 2014). Although unplanned pregnancy is common in the general population (Finer & Zolna, 2011), with HIV infection, the potential for negative health consequences for women, partners, and neonates is high.…”

“…PCC by health-care providers has been associated with a reduced risk of unplanned pregnancy (Rahangdale et al, 2014). PCC for women living with HIV offers the opportunity to reduce the risk of unintended pregnancy, perinatal and sexual HIV transmission, fetal loss, pre-term delivery, low birth weight and birth defects, as well as adverse health outcomes for the woman and her partner by optimizing health and knowledge before conceiving (Hoyt et al, 2012; Panel on Treatment, 2014).…”

High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India: need to emphasize dual method use?

“…Only 43 before pregnancy could be helpful in reducing unwanted pregnancies (Barbosa et al, 2012;Rahangdale et al, 2014). Also informing all fecund HIV infected women of childbearing age group about MTCT and its prevention at the time of diagnosis should be considered for improving informed decision making among women.…”