title: Pregnancy intentions among women living with HIV in the United States.
abstract: BACKGROUND
  The number of HIV-infected women giving birth in the United States is increasing. Research on pregnancy planning in HIV-infected women is limited.
  
  
  METHODS
  Between January 1 and December 30, 2012, pregnant women with a known HIV diagnosis before conception at 12 US urban medical centers completed a survey including the London Measure of Unplanned Pregnancy (LMUP) scale. We assessed predictors of LMUP category (unplanned/ambivalent versus planned pregnancy) using bivariate and multivariable analyses.
  
  
  RESULTS
  Overall, 172 women met inclusion criteria and completed a survey. Based on self-report using the LMUP scale, 23% women had an unplanned pregnancy, 58% were ambivalent, and 19% reported a planned pregnancy. Women were at lower risk for an unplanned or ambivalent pregnancy if they had previously given birth since their HIV diagnosis [adjusted relative risk (aRR) = 0.67, 95% confidence interval (CI): 0.47 to 0.94, P = 0.02], had seen a medical provider in the year before the index pregnancy (aRR = 0.60, 95% CI: 0.46 to 0.77, P < 0.01), or had a patient-initiated discussion of pregnancy intentions in the year before the index pregnancy (aRR = 0.63, 95% CI: 0.46 to 0.77, P < 0.01). Unplanned or ambivalent pregnancy was not associated with age, race/ethnicity, or educational level.
  
  
  CONCLUSIONS
  In this multisite US cohort, patient-initiated pregnancy counseling and being engaged in medical care before pregnancy were associated with a decreased probability of unplanned or ambivalent pregnancy. Interventions that promote healthcare engagement among HIV-infected women and integrate contraception and preconception counseling into routine HIV care may decrease the risk of unplanned pregnancy among HIV-infected women in the United States.
authors: *Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; †Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD; ‡Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX; §Department of Gynecology and Obstetrics, Emory University, Atlanta, GA; ‖Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; ¶Department of Maternal Fetal Medicine, Women's Hospital, Baton Rouge, LA; #Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; **Departments of Family/Childhealth and Caregiving and Health Behavior, University of Alabama at Birmingham, Birmingham, AL; ††Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC; ‡‡Department of Medicine, Boston Medical Center, Boston, MA; §§Department of Medicine, Alpert Medical School of Brown University, Providence, RI; ‖‖Department of Medicine, Emory University, Atlanta, GA; ¶¶Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL; and ##Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
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mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003625:Data Collection; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D033182:Intention; D011247:Pregnancy; D014481:United States; D014505:Urban Population; D055815:Young Adult