Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV.
OBJECTIVE
To determine frequency and outcomes of pregnancy in US women with HIV before and after introduction of highly active antiretroviral therapy (HAART).


METHODS
Prospective cohort study at six US centers.


METHODS
HIV seropositive and at-risk seronegative women reported pregnancy outcomes at 6-month intervals during the period 1 October 1994 to 31 March 2002. Outcomes were tabulated and pregnancy rates calculated. Logistic regression defined outcome correlates.


RESULTS
Pregnancy rates were 7.4 and 15.2 per 100 person-years in seropositive and seronegative women, respectively (P < 0.0001). Among seropositives, 119 (36%) pregnancies ended in live birth, six (2%) in stillbirth, 126 (36%) in abortion, 83 (24%) in miscarriage, 16 (5%) in ectopic pregnancy, and two (1%) in other outcomes (P = nonsignificant versus seronegatives). Independent baseline correlates of conception in seropositives included younger age [odds ratio (OR), 1.20; 95% confidence interval (CI), 1.16-1.23], prior abortion (OR, 1.79; 95% CI, 1.25-2.63), lower HIV RNA levels (OR, 1.30; 95% CI, 1.10-1.54 for each log decrease), and being unmarried (OR, 1.59; 95% CI, 1.02-2.44). Baseline antiretroviral use at baseline was linked to lower conception risk (OR, 0.34; 95% CI, 0.49-0.98 for mono- or combination therapy; OR, 0.34; 95% CI, 0.03-4.28 for HAART). Abortion was less likely during the HAART era, (OR, 0.68; 95% CI, 0.35-1.33 during the early HAART era; OR, 0.46; 95% CI, 0.23-0.90 during the later HAART era, compared with before HAART).


CONCLUSIONS
Women with HIV were less likely to conceive than at-risk uninfected women, but pregnancy outcomes were similar. Abortion became less common after the introduction of HAART.
Massad
L Stewart
LS
Department of Obstetrics and Gynecology, Southern Illinois University, Springfield, Illinois, 62794-9640, USA.
Springer
Gayle
G
Jacobson
Lisa
L
Watts
Heather
H
Anastos
Kathryn
K
Korn
Abner
A
Cejtin
Helen
H
Stek
Alice
A
Young
Mary
M
Schmidt
Julie
J
Minkoff
Howard
H
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D018873:Pregnancy Rate; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology