Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study

Iyun, Victoria; Brittain, Kirsty; Phillips, Tamsin K; Roux, Stanzi M le; McIntyre, James; Zerbe, Allison; Petro, Gregory; Abrams, Elaine J.; Myer, Landon

doi:10.1136/bmjopen-2017-019979

Cited by 51 publications

(62 citation statements)

References 28 publications

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“…Further, in the subset cohort of HIV‐infected women followed longitudinally through delivery, we found that high GWG was associated with increased risk of spontaneous PTD and HBW infants. In a country with both a high prevalence of obesity in women of child‐bearing age [11] and a high prevalence of HIV in pregnant women [39], our findings highlight the need for weight management interventions before and during pregnancy to minimise adverse birth outcomes.…”

Section: Discussionmentioning

confidence: 95%

Elevated body mass index during pregnancy and gestational weight gain in HIV‐infected and HIV‐uninfected women in Cape Town, South Africa: association with adverse birth outcomes

Madlala

Malaba

Newell

et al. 2020

Tropical Med Int Health

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objectives To examine the association between maternal body mass index (BMI) and gestational weight gain (GWG) and adverse birth outcomes in HIV-infected and HIV-uninfected women.methods In an urban South African community, 2921 consecutive HIV-infected and HIVuninfected pregnant women attending primary healthcare services were assessed at their first antenatal visit. A subset of HIV-infected women enrolled in a longitudinal study was assessed three times during pregnancy. All women had birth outcome data from medical records and study questionnaires. In analyses, the associations between BMI, GWG, maternal factors and adverse birth outcomes were assessed with logistic regression models.results The estimated pre-pregnancy BMI median was 29 kg/m 2 (IQR, 24-34) overall, 29 kg/m 2 (IQR, 24-34) for HIV-uninfected and 28 kg/m 2 (IQR, 24-34) for HIV-infected women; HIV prevalence was 38%. In adjusted models, increased BMI in the overall cohort was positively associated with age, haemoglobin and parity at first antenatal visit. Maternal obesity was associated with increased likelihood of having high birthweight (aOR 2.54, 95% CI 1.39-4.66) and large size for gestational age (aOR 1.66, 95% CI 1.20-2.31) infants. In the subset cohort, GWG was associated with increased likelihood of spontaneous preterm delivery (aOR 4.35, 95% CI 1.55-12.21) and high birthweight (aOR 3.00, 95% CI 1.22-7.34) infants.conclusion Obesity during pregnancy is prevalent in this setting and appears associated with increased risk of adverse birth outcomes in both HIV-infected and HIV-uninfected women. Weight management interventions targeting women of child-bearing age are needed to promote healthy pregnancies and reduce adverse birth outcomes.keywords body mass index, gestational weight gain, preterm delivery, birthweight, size for gestational age Sustainable Development Goals (SDGs): SDG 3 (good health and well-being), SDG 17 (partnerships for the goals) Tropical Medicine and International Health

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Section: Discussionmentioning

confidence: 95%

Elevated body mass index during pregnancy and gestational weight gain in HIV‐infected and HIV‐uninfected women in Cape Town, South Africa: association with adverse birth outcomes

Madlala

Malaba

Newell

et al. 2020

Tropical Med Int Health

Self Cite

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“…A plausible explanation for this is that in a marital union there are open communication channels between the two individuals and this facilitates open discussion on reproductive-related issues like child-bearing and contraceptive use. Studies done elsewhere 15,16,31 also documented that WLH in a relationship were most likely to use contraception if there was open partner discussion among married couples. These communication channels 23 and South Africa 12,24,31 , demonstrate similar results.…”

Section: Discussionmentioning

confidence: 98%

“…Studies done elsewhere 15,16,31 also documented that WLH in a relationship were most likely to use contraception if there was open partner discussion among married couples. These communication channels 23 and South Africa 12,24,31 , demonstrate similar results. Our study also found that experiencing a higher number of pregnancies increased the likelihood of experiencing unintended pregnancy among WLH.…”

Section: Discussionmentioning

confidence: 98%

“…In a study done in Uganda 40 , it was found that individuals who had taken ART for a long time hardly received continuous ART adherence education, experienced treatment fatigue and were less likely to adhere to their treatment. Studies in South Africa 24,31 however found that women who had been newly diagnosed with HIV were more likely to Table 3. Predictors for unintended pregnancy among HIV infected women in Northern Uganda.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and predictors for unintended pregnancy among HIV-infected pregnant women in Lira, Northern Uganda: a cross-sectional study

Napyo

Nankabirwa

Mukunya

et al. 2020

Sci Rep

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Prevention of unintended pregnancies is a global strategy to eliminate mother-to-child transmission of HIV. Factors surrounding unintended pregnancy among women living with HIV are not well understood. We aimed to determine the prevalence and predictors for unintended pregnancy among these women in Northern Uganda. We conducted a cross-sectional survey among 518 women using a structured questionnaire. We asked questions on socio-demographic, reproductive-related and HIV-related characteristics. We conducted multivariable logistic regression and reported adjusted odds ratios. The prevalence of unintended pregnancy was 41.1%. The predictors for unintended pregnancy were: being single (not living with a partner or being in a marital union), having five or more children and taking antiretroviral drugs for long periods of time. HIV counselling services should target women living with HIV who are not in a marital union, those having a higher parity and those who have taken ART for longer periods.

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“…Also, over 70% of women who knew their HIV positive conceived on ART. This high fertility intention among women who started ART before a pregnancy was also demonstrated among HIV positive women in the Western Cape Province of South Africa [25]. Furthermore, women with pre-pregnancy ART entered ANC with higher immunological status compared to women who were undiagnosed or diagnosed but not on ART before the most recent pregnancy, but this difference faded at the end of the pregnancy.…”

Section: Discussionmentioning

confidence: 56%

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa

et al. 2020

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Background Despite the success of prevention of mother to child transmission (PMTCT) program in South Africa, the 30% HIV prevalence among women of childbearing age requires the PMTCT program to be maximally efficient to sustain gains in the prevention of vertical HIV transmission. We aimed to determine the immunologic and virologic status at entry into antenatal care (ANC) and at childbirth among HIV positive women who conceived under the CD4<500 cells/μl antiretroviral therapy (ART) eligibility threshold and universal test and treat (UTT) policies in the Gauteng province of South Africa. Method We conducted a retrospective cohort study of 692 HIV positive adult (>18 years) postpartum women who gave birth between September 2016 and December 2017. Demographic, viral load (VL) and CD4 data at ANC start (3-9 months before delivery) and delivery (3 months before/after) were obtained from medical records of consenting women. We compared CD4�500 cell/μl and viral load (VL) suppression (<400 copes/ml) rates at ANC start and delivery among women with a pre-pregnancy ART, women known HIV positive but with inpregnancy ART and newly diagnosed women with in-pregnancy ART. Predictors of having a high CD4 and suppressed VL were assessed by log-binomial regression. Results Of the 692 participants, 394 (57.0%) had CD4 data and 326 (47.1%) had VL data. Overall women with a pre-pregnancy ART were more likely to start ANC with CD4 count�500 cell/μl (46.3% vs 24.8%, adjusted risk ratio (aRR) = 1.9; 95% confidence interval (95% CI): 1.4-2.5), compared to newly diagnosed women. This difference was no longer apparent at the time of delivery (aRR 1.2 95% CI: 0.4-3.7). Similarly, viral suppression at delivery was

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Prevalence and determinants of unplanned pregnancy in HIV-positive and HIV-negative pregnant women in Cape Town, South Africa: a cross-sectional study

Cited by 51 publications

References 28 publications

Elevated body mass index during pregnancy and gestational weight gain in HIV‐infected and HIV‐uninfected women in Cape Town, South Africa: association with adverse birth outcomes

Elevated body mass index during pregnancy and gestational weight gain in HIV‐infected and HIV‐uninfected women in Cape Town, South Africa: association with adverse birth outcomes

Prevalence and predictors for unintended pregnancy among HIV-infected pregnant women in Lira, Northern Uganda: a cross-sectional study

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa

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