Prevalence and outcomes of pregnancies in women with HIV over a 20-year period. AIDS
Kowalska et al. evaluated time trends and outcomes of pregnancies among European women with HIV between 1996 and 2015 in the EuroSIDA cohort.
Audits were performed annually to collect information on pregnancies in female cohort participants aged between 16 and 50 years. Outcomes were categorized as birth of a HIV negative child, HIV positive child or child with unknown HIV status, stillbirth, spontaneous abortion, medical abortion, still pregnant or unknown. Pregnancy trends were analysed in three distinct periods: 1996-2002, 2003-2009 and 2010-2015, and logistic regression with generalized estimating equations was performed to assess factors associated with pregnancy.
The study included 5’535 women of reproductive age, median age of 33 years (IQR 29-39 years), most were of white ethnicity, and 62% acquired HIV heterosexually. Of those women, 4’217 (76.2%) had pregnancy information available. Between 1996 and 2015, 912 women reported a total of 1’315 pregnancies. The proportion of women who reported at least one pregnancy was 15.3% between 1996 and 2002, 17.3% between 2003 and 2009, and 12.6% between 2010 and 2015. In multivariable analyses, younger women, women with previous pregnancies and participants from Western/Central and Northern Europe were most likely to report a pregnancy, whereas women from South, Central East and Eastern Europe and individuals with previous AIDS-defining illnesses were less likely to report a pregnancy. Out of 690 live births (69.1%), 23 children were HIV-positive (3.3%), 342 were HIV-negative (49.6%), and the HIV status was unknown in 325 (47.1%). Spontaneous abortions occurred in 103 pregnancies, and 199 women had medical abortions.
In summary, the present study shows that around 22% of women in the EuroSIDA cohort reported one or more pregnancies. The highest proportion of pregnancies occurred between 2003 and 2009, and declined in recent years – reflecting trends in the general population. Women reported a high rate of medical abortions, highlighting the importance of integrating family planning and ensuring access to sexual health counselling for women with HIV.