Justyna D Kowalska1, Annegret Pelchen-Matthews, Lene Ryom, Marcelo H Losso, Tatiana Trofimova, Viktar M Mitsura, Irina Khromova, Dzmitry Paduta, Christoph Stephan, Pere Domingo, Elzbieta Bakowska, Antonella d'Arminio Monforte, Lars Oestergaard, Elzbieta Jablonowska, Anastasiia Kuznetsova, Santiago Moreno, Marta Vasylyev, Christian Pradier, Manuel Battegay, Linos Vandekerckhove, Antonella Castagna, Dorthe Raben, Amanda Mocroft. 1. Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Hospital J.M. Ramos Mejia, Buenos Aires, Argentina Novgorod Centre for AIDS prevention and control, Novgorod the Great, Russian Federation Gomel State Medical University, Gomel, Belarus Centre for HIV/AIDS & Infectious Diseases, Kaliningrad, Russian Federation Gomel Regional Centre for Hygiene, Gomel, Belarus J.W. Goethe University Hospital, Frankfurt, Germany Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Wojewodzki Szpital Zakazny, Warsaw, Poland ASST Santi Paolo e Carlo, University of Milan, Milan, Italy Aarhus Universitetshospital, Skejby, Denmark Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland Kharkov State Medical University, Kharkov, Ukraine Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain Lviv Regional HIV/AIDS Prevention and Control Center, Lviv, Ukraine CHU Nice Hopital de l' Archet 1, Nice, France Department of Medicine, University Hospital Basel, Basel, Switzerland Ghent University Hospital, Ghent, Belgium Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
Abstract
OBJECTIVE: To evaluate time trends in pregnancies and pregnancy outcomes among women living with HIV in Europe. DESIGN: European multicentre prospective cohort study. METHODS: EuroSIDA has collected annual cross-sectional audits of pregnancies between 1996 and 2015. Pregnancy data were extracted and described. Odds of pregnancy were modelled, adjusting for potential confounders using logistic regression with generalised estimating equations. RESULTS: Of 5535 women aged 16 to <50 years, 4217 (76.2%) had pregnancy information available, and 912 (21.6%) reported 1315 pregnancies. The proportions with at least one pregnancy were 28.1% (321/1143) in East, 24.5% (146/596) in North, 19.8% (140/706) in West/Central, 19.3% (110/569) in Central East and 16.2% (195/1203) in South Europe. Overall 319 pregnancies (24.3%) occurred in 1996-2002, 576 (43.8%) in 2003-2009 and 420 (31.9%) in 2010-2015. After adjustment, the odds of pregnancy were lower in 1996-2002, in South, Central East and East compared to West/Central Europe, in older women, those with low CD4 counts or with prior AIDS, and higher in those with a previous pregnancy or who were HCV positive.Outcomes were reported for 999 pregnancies in 1996-2014, with 690 live births (69.1%), seven stillbirths (0.7%), 103 spontaneous (10.3%) and 199 medical abortions (19.9%). CONCLUSIONS: Around 20% of women in EuroSIDA reported a pregnancy, with most pregnancies after 2002, when more effective antiretroviral therapy became available. Substantial differences were seen between European regions. Further surveillance of pregnancies and outcomes among women living with HIV is warranted to ensure equal access to care.
OBJECTIVE: To evaluate time trends in pregnancies and pregnancy outcomes among women living with HIV in Europe. DESIGN: European multicentre prospective cohort study. METHODS: EuroSIDA has collected annual cross-sectional audits of pregnancies between 1996 and 2015. Pregnancy data were extracted and described. Odds of pregnancy were modelled, adjusting for potential confounders using logistic regression with generalised estimating equations. RESULTS: Of 5535 women aged 16 to <50 years, 4217 (76.2%) had pregnancy information available, and 912 (21.6%) reported 1315 pregnancies. The proportions with at least one pregnancy were 28.1% (321/1143) in East, 24.5% (146/596) in North, 19.8% (140/706) in West/Central, 19.3% (110/569) in Central East and 16.2% (195/1203) in South Europe. Overall 319 pregnancies (24.3%) occurred in 1996-2002, 576 (43.8%) in 2003-2009 and 420 (31.9%) in 2010-2015. After adjustment, the odds of pregnancy were lower in 1996-2002, in South, Central East and East compared to West/Central Europe, in older women, those with low CD4 counts or with prior AIDS, and higher in those with a previous pregnancy or who were HCV positive.Outcomes were reported for 999 pregnancies in 1996-2014, with 690 live births (69.1%), seven stillbirths (0.7%), 103 spontaneous (10.3%) and 199 medical abortions (19.9%). CONCLUSIONS: Around 20% of women in EuroSIDA reported a pregnancy, with most pregnancies after 2002, when more effective antiretroviral therapy became available. Substantial differences were seen between European regions. Further surveillance of pregnancies and outcomes among women living with HIV is warranted to ensure equal access to care.