title: High prevalence of unintended pregnancies in HIV-positive women of reproductive age in Ontario, Canada: a retrospective study.
abstract: OBJECTIVE
  There is speculation, but there are few data, on the high rates of unintended pregnancies in HIV-positive women. We investigated rates and correlates of unintended pregnancies among HIV-positive women of reproductive age.
  
  
  METHODS
  A cross-sectional study was conducted with recruitment stratified to match the geographical distribution of HIV-positive women of reproductive age (18-52 years) living in Ontario, Canada. Women, recruited from 38 sites between October 2007 and April 2009, were invited to complete a 189-item self-administered survey. This analysis focused on questions relating to pregnancy and whether the last pregnancy was intended. Logistic regression models were fitted to calculate unadjusted and adjusted odds ratios of correlates of unintended pregnancies occurring after HIV diagnosis. Happiness with unintended pregnancies was also assessed.
  
  
  RESULTS
  The median age at the time of the survey of the 416 participating HIV-positive women who were previously pregnant (53% before and 47% after HIV diagnosis) was 38 years [interquartile range (IQR) 33-44 years] and their last pregnancy was a median of 8 years (IQR 3-14 years) prior to the survey (n=283). Fifty-nine per cent were born outside Canada and 47% were of African ethnicity. Of the 416, 56% [95% confidence interval (CI) 51-61%] identified that their last pregnancy was unintended (57% before and 54% after HIV diagnosis). In the multivariable model, significant correlates of unintended pregnancy after HIV diagnosis were: marital status (P=0.01) and never having given birth (P=0.01). Women were less happy if their pregnancy was unintended (P<0.01).
  
  
  CONCLUSIONS
  The prevalence of unintended pregnancy was high in this cohort. Pregnancy planning programmes are needed for this population to decrease fetal and maternal complications and reduce vertical and horizontal transmission.
authors: Women's College Research Institute, Women's College Hospital, Toronto, Ontario. mona.loutfy@wchospital.ca
authors: Mr
authors: M
authors: Loutfy
authors: Jm
authors: J
authors: Raboud
authors: J
authors: J
authors: Wong
authors: Mh
authors: M
authors: Yudin
authors: C
authors: C
authors: Diong
authors: Sl
authors: S
authors: Blitz
authors: Sl
authors: S
authors: Margolese
authors: Ta
authors: T
authors: Hart
authors: G
authors: G
authors: Ogilvie
authors: K
authors: K
authors: Masinde
authors: We
authors: W
authors: Tharao
authors: G
authors: G
authors: Linklater
authors: K
authors: K
authors: Salam
authors: F
authors: F
authors: Ongoiba
authors: Jb
authors: J
authors: Angel
authors: Fm
authors: F
authors: Smaill
authors: Ar
authors: A
authors: Rachlis
authors: Ed
authors: E
authors: Ralph
authors: Sl
authors: S
authors: Walmsley
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016015:Logistic Models; D009864:Ontario / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D049168:Pregnancy, Unplanned; D015995:Prevalence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult