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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000014
Clinical Science

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)

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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.

© 2014 by Lippincott Williams & Wilkins

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