Pregnancy Intentions Among Women Living With HIV in the United States

Rahangdale, Lisa MD, MPH*; Stewart, Amanda MD; Stewart, Robert D. MD; Badell, Martina MD§; Levison, Judy MD, MPH; Ellis, Pamala BSN; Cohn, Susan E. MD, MPH#; Kempf, Mirjam-Colette MPH, PhD**; Lazenby, Gweneth B. MD††; Tandon, Richa MD‡‡; Rana, Aadia MD§§; Nguyen, Minh Ly MD, MPH‖‖; Sturdevant, Marcia S. MD¶¶; Cohan, Deborah MD, MPH##; on behalf of the HOPES (HIV and OB Pregnancy Education Study)

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 March 2014 - Volume 65 - Issue 3 - p 306–311
doi: 10.1097/QAI.0000000000000014
Clinical Science

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.

*Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC;

Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD;

Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX;

§Department of Gynecology and Obstetrics, Emory University, Atlanta, GA;

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX;

Department of Maternal Fetal Medicine, Women's Hospital, Baton Rouge, LA;

#Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL;

**Departments of Family/Childhealth and Caregiving and Health Behavior, University of Alabama at Birmingham, Birmingham, AL;

††Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC;

‡‡Department of Medicine, Boston Medical Center, Boston, MA;

§§Department of Medicine, Alpert Medical School of Brown University, Providence, RI;

‖‖Department of Medicine, Emory University, Atlanta, GA;

¶¶Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL; and

##Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.

Correspondence to: Lisa Rahangdale, MD, MPH, Department of Obstetrics and Gynecology, University of North Carolina, 3031 Old Clinic Building, CB # 7570, Chapel Hill, NC 27516 (e-mail: Lisa_Rahangdale@med.unc.edu).

Supported 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.

Presented in part at the 2013 20th Conference on Retroviruses and Opportunistic Infections, March 5, 2013, Atlanta, GA.

The authors have no funding or conflicts of interest to disclose.

Received July 01, 2013

Accepted September 16, 2013

© 2014 by Lippincott Williams & Wilkins