Rate, correlates and outcomes of repeat pregnancy in <scp>HIV</scp>‐infected women

Floridia, Marco; Tamburrini, Enrica; Masuelli, Giulia; Martinelli, Pasquale; Spinillo, Arsenio; Liuzzi, Giuseppina; Vimercati, Antonella; Alberico, Salvatore; Maccabruni, Anna; Pinnetti, Carmela; Frisina, Valentina; Dalzero, Serena; Ravizza, Marina

doi:10.1111/hiv.12473

Cited by 9 publications

(12 citation statements)

References 11 publications

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“…Trends and patterns of pregnancy and childbirth may vary between different countries. Our results are consistent with other studies showing that women with HIV infection are increasingly choosing to become pregnant, even to have repeated pregnancies after their HIV diagnosis [51719].…”

Section: Discussionsupporting

confidence: 93%

“…One woman conceived 4 times after HIV diagnosis including 3 live births and 1 miscarriage. Previous studies have reported a recent increase in repeated pregnancies among women with HIV infection [5171819]. Repeated pregnancies are not just a consequence of lack of or ineffective contraception, but also reflect the desire of these individuals to have multiple children [517].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported a recent increase in repeated pregnancies among women with HIV infection [5171819]. Repeated pregnancies are not just a consequence of lack of or ineffective contraception, but also reflect the desire of these individuals to have multiple children [517]. In our study, 63.6% (7/11) of first-time pregnancies were intended, while all 6 repeated pregnancies were also intended due to the desire for additional childbearing; partners were HIV negative in 80% of these (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Changing Trends in Pregnancy and Childbirth among Women Living with Human Immunodeficiency Virus at a Tertiary Hospital in Korea: A 28-Year Experience

Kang

Lee

et al. 2019

Infect Chemother

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Background The reports about fertility desire and pregnancy outcome among women infected with human immunodeficiency virus (HIV) in Korea are scarce. This study aimed to determine the changing trend in pregnancy incidence among women infected with HIV in Korea. Materials and Methods We retrospectively reviewed the medical records of women infected with HIV visiting Pusan National University Hospital between January 1990 and October 2018. Results A total of 149 women with HIV infection visited the study hospital. Among them, 33 pregnancies in 24 (16.1%) women were identified. There were 17 live births (51.5%) and 13 abortions (39.4%), whereas 3 women (9.1%) were transferred to another hospital or were lost to follow-up. The number of live birth rose from 0 in 1990-1998 to 17 in 1999-2018. The proportion of repeated pregnancies after HIV diagnosis also increased steeply, from 14.3% in 1999-2008 to 50% in 2009-2018. However, the number of abortions also increased over time. There were 8 induced abortions, 7 (87.5%) of them were diagnosed with HIV infection during pregnancy and 3 (37.5%) were unplanned pregnancies. Eighteen babies, including 1 twin case, were born from 17 births. There was no mother-to-child HIV transmission in our study. Conclusion The number of pregnancies among women with HIV infection and repeated pregnancies after HIV diagnosis has been increasing in Korea, probably due to the desire of HIV patients to have more children. However, the number of abortions also increased, probably due to health concerns and uncertain pregnancy outcome.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Changing Trends in Pregnancy and Childbirth among Women Living with Human Immunodeficiency Virus at a Tertiary Hospital in Korea: A 28-Year Experience

Kang

Lee

et al. 2019

Infect Chemother

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“…These long-term complications have not been studied in HIV-related pregnancies. However, an increasing proportion of women living with HIV desire to have several children [ 28 , 29 ]. This was also true in our study, where 37% of women had more than one child after being diagnosed with HIV.…”

Section: Discussionmentioning

confidence: 99%

Most women living with HIV can deliver vaginally—National data from Finland 1993–2013

et al. 2018

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IntroductionVaginal delivery has been recommended for more than ten years for women living with HIV (WLWH) with good virological control. However, in Europe most WLWH still deliver by cesarean section (CS). Our aim was to assess the rate of vaginal delivery and the indications for CS in WLWH over 20 years in a setting of low overall CS rate.Materials and methodsThis was a retrospective study of all WLWH delivering in Finland 1993–2013. We identified the women by combining national health registers and extracted data from patient files.ResultsThe study comprised 212 women with 290 deliveries. Over 35% of the women delivered several children during the study years. During 2000–2013, with consistent viral load monitoring, 80.0% showed HIV viral loads <50 copies/mL in the last measurement preceding the delivery. Altogether 74.5% of all WLWH delivered vaginally and the rate of both elective CS and emergency CS was 12.8% each. For most CSs (63.5%) the indication was obstetrical, for 28.4% it was avoiding HIV transmission and for 0.7% it was mother’s request. In hospitals with less than ten HIV-related deliveries during the study period, the rate of elective CS was higher than in more experienced hospitals (22.7% versus 10.6% [p = 0.024]). No perinatal HIV transmissions occurred.ConclusionsMost WLWH can achieve good virological control and deliver vaginally. This will help them to maintain their future child bearing potential and reduce CS-related morbidity.

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“…4 Likewise, Floridia et al showed that the CD4 count early in pregnancy and viral suppression at delivery improved in repeat pregnancies, and was associated with greater ART coverage. 5 However, specific differences in antiretroviral (ARV) regimens in repeat pregnancies and associations with birth outcomes were not examined.…”

Section: Introductionmentioning

confidence: 99%

Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth

O’Brien

Williams

Huo

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND-Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. Additionally, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized.METHODS-We studied WLHIV with ≥2 liveborn infants enrolled into the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring for ART Toxicities (SMARTT) study between 2007-2018, comparing CD4 counts and viral loads (VLs) between two consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression, and the association of PI/INSTI use during pregnancy with odds of preterm birth.RESULTS-There were 736 women who had ≥2 liveborn children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. While > 80% of women achieved VL suppression during pregnancy, more than half had detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with 1 st trimester PI initiation (adjusted odds ratio [OR] 1.97; 95% CI 1.27, 3.07) compared to those not receiving PIs during pregnancy, and for 1 st trimester INSTI initiation (adjusted OR 2.39; 95% CI 1.04, 5.46) compared to those never using INSTIs during pregnancy. CONCLUSIONS-MostWLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with higher risk of preterm birth.

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Rate, correlates and outcomes of repeat pregnancy in HIV‐infected women

Cited by 9 publications

References 11 publications

Changing Trends in Pregnancy and Childbirth among Women Living with Human Immunodeficiency Virus at a Tertiary Hospital in Korea: A 28-Year Experience

Changing Trends in Pregnancy and Childbirth among Women Living with Human Immunodeficiency Virus at a Tertiary Hospital in Korea: A 28-Year Experience

Most women living with HIV can deliver vaginally—National data from Finland 1993–2013

Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth

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