Pregnancies before and after HIV diagnosis in a European cohort of HIV-infected women

Objectives: Because most HIV-infected women are of reproductive age, we inv estigated whether their reproduction planning was affected by their HIV dia gnosis. Design: The European women study is a prospective, multicentre cohort of 48 5 HIV-infected women with a known interval of seroconversion. Methods: The incidence of pregnancy was measured with person-time methods. Generalized estimating equation analysis was used to determine risk factors for pregnancy and pregnancy outcomes. Results: In 449 women, the age-adjusted incidence of pregnancies decreased from 8.6 before HIV diagnosis to 8.2 and 6.0 per 100 person-years in 0-4 an d over 4 years after HIV diagnosis, respectively (P = 0.14). The proportion of induced abortions increased from 42% before to 53% alter HIV diagnosis (P < 0.05). The risk of spontaneous abortion did not increase as a result o f HIV infection. Since 1995, the proportion of births increased (P = 0.009) , whereas that of induced abortions decreased (P = 0.01) compared with earl ier years. An increased risk of pregnancy after HIV diagnosis was found in northern and central European women compared with southern European women; there was a lower risk in single women than in women with a steady partner. Of all pregnant women, single women, women between 15 and 25 years of age, and women with multiple partners were at increased risk for induced aborti on both before and after HIV diagnosis. Conclusion: The incidence of pregnancy decreased with HIV disease progressi on. Pregnancies after HIV diagnosis appear to be related largely to social and cultural attitudes. The number of induced abortions was significantly i ncreases thereafter. high before HIV diagnosis and it (C) 2000 Lippincott W illiams & Wilkins.