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Pregnancies and Live Births Stable/Rising
Since 2002 in European Women With HIV
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17th European AIDS Conference, November 6-9, 2019, Basel
Mark Mascolini
Since 2002, when more effective combination antiretroviral therapy (cART) started becoming available, the proportion of HIV-positive European women becoming pregnant rose significantly [1]. But after 2009, the pregnancy rate dropped. More than two thirds of pregnancies resulted in live births.
Fertility rates and birth outcomes have improved in women across Europe [2]. But because pregnancy rates and outcomes remain uncertain in European women with HIV, EuroSIDA investigators undertook this study.
EuroSIDA includes more than 22,000 people with HIV in 35 European countries, Israel, and Argentina. From 1996 through 2015, EuroSIDA researchers collected pregnancy information in annual cross-sectional audits. For this analysis they considered three periods: pre-cART: 1996-2002; cART: 2003-2009; and modern cART: 2010-2015. The analysis focused on women of reproductive age (16 to 50) with pregnancy information available in at least 1 study year. To estimate odds of pregnancy and live births, the investigators used logistic regression with generalized estimating equations accounting for repeated pregnancy in individual women.
Among 5535 women 16 to 50 years old, 4217 (76%) had pregnancy information available. Most women, 83%, were white, and 30% became infected when injecting drugs. Median baseline age stood at 33.2, CD4 count at 374, viral load at 400 copies, and time since HIV diagnosis at 4.3 years.
Across the three study periods, proportions of women who ever took cART rose from 34.8% to 67.4% to 83.9%. Proportion with prior AIDS stayed flat at about 20%. Proportions of current smokers rose modestly from 27.7% to 33.8% to 32.6%. Proportions of overweight or obese women climbed from 6.6% to 12.1% to 17.8%. Across the three study periods, the proportion of women with a viral load below 400 jumped from 16.4% to 46.8% to 65.5%, while median CD4 count rose from 270 to 447.5 to 506.
Age at pregnancy rose in every EuroSIDA region (South, West Central, North, Central East, and East) across the three study periods, with the greatest increases in the South, Central East, and East. The overall proportion of women with at least one pregnancy rose modestly from 15.3% in 1996-2002 to 17.3% in 2003-2009, before falling to 12.6% in 2010-2015. The overall drop across those three periods was steepest in the East (47.4% to 25.3% to 18.5%) and did not rise across all three periods in any of the other regions.
In an adjusted analysis, two variables boosted the odds of pregnancy: Previously pregnant women had nearly doubled odds of pregnancy (adjusted odds ratio [aOR] 1.88, 95% confidence interval [CI] 1.58 to 2.23, P < 0.0001). Women with prior HCV had about 40% higher odds of pregnancy (aOR 1.41, 95% CI 1.11 to 1.78, P = 0.0044). Seven variables independently lowered odds of pregnancy: 1996-2002 period versus 2003-2009, every additional 10 years of age, baseline CD4 count below 200 (versus above 500), prior AIDS, and living in the South, Central East, or East regions.
Researchers had pregnancy outcome data for 999 pregnancies in 1996-2014. They counted 199 medical abortions (20%), 103 spontaneous abortions (10%), and 7 stillbirths (0.7%). Of 690 live births (69%), 342 (49.5%) were born without HIV, 23 (3.3%) with HIV, and the rest with an unknown HIV status.
One factor independently predicted greater odds of live birth: previous pregnancy (aOR 2.29, 95% CI 1.28 to 4.08, P 0.0051). Four factors independently predicted lower odds of live birth: 1996-2002 versus 2003-2009 (aOR 0.37, 95% CI 0.19 to 0.70, P = 0.0022), every additional 10 years of age (aOR 0.62, 95% CI 0.38 to 1.00, P = 0.049), North EuroSIDA region (versus West Central) (aOR 0.38, 95% CI 0.17 to 0.88, P = 0.024), and prior HCV (aOR 0.31, 95% CI 0.11 to 0.87, P = 0.026).
The EuroSIDA team proposed that the next step in this work is to analyze the long-term impact of pregnancy on retention in care and on maintaining cART.
References
1. Kowalska JD, Pelchen-Matthews A, Ryom L, et al. Prevalence and outcomes of pregnancies over a 20 year period: the EuroSIDA study. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PS1/3.
2. Eurostat Statistics Explained. Fertility statistics. https://ec.europa.eu/eurostat/statistics-explained/Fertility_statistics
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