PREGNANCY RATES AMONG WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Objective. To examine pregnancy rates among women infected with human immunodeficiency virus (HIV). Methods. The authors used data from an o ngoing survey of medical records of 3915 women who were 15-44 years of age, infected with HIV, and who received care between January 1990 an d August 1994 in more than 90 clinics, hospitals, and private practice s in 11 United States cities. Results. At enrollment, 570 (14%) of the se women were pregnant. Pregnancy rates at entry varied significantly (P < .05) by age in years (15-19 [47%], 20-24 [30%], 25-29 [18%]; 30-3 4 [11%]; 35-39 [5%]; 40-44 [2%]); clinical status (with AIDS opportuni stic illness [3%], without AIDS opportunistic illness [17%]); and race -ethnicity (white [12%], black [17%], Hispanic [8%], Asian [0%], Nativ e American [30%]) but not by mode of exposure (injecting drug use [10% ], heterosexual contact [15%], and blood transfusion [12%]). After enr ollment, 5.8% of women became pregnant each year. New pregnancies were significantly less likely to occur among women with an AIDS opportuni stic illness (adjusted rate ratio 0.4, 95% confidence Interval [CI] 0. 2-0.6), and significantly more likely to occur among women who were le ss than 25 years of age (adjusted rate ratio 8.3, 95% CI 5.3-13.2) and who were black (adjusted rate ratio 1.6, 95% CI 1.2-2.1). Among women who were pregnant at enrollment or during observation, 12% were pregn ant more than once. Conclusions. High rates of pregnancy at entry to m edical care among HIV-infected women stress the importance of counseli ng and voluntary testing as routine obstetric-gynecologic practice. In some groups, rates of new pregnancies remain high; standard HIV care for women should include family planning services and assurance that i f a woman chooses to practice contraception, contraceptives will be av ailable and affordable.