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Pregnancies before and after HIV diagnosis in a European cohort of HIV-infected women

ObjectivesBecause most HIV-infected women are of reproductive age, we investigated whether their reproduction planning was affected by their HIV diagnosis. DesignThe European women study is a prospective, multicentre cohort of 485 HIV-infected women with a known interval of seroconversion. MethodsThe incidence of pregnancy was measured with person–time methods. Generalized estimating equation analysis was used to determine risk factors for pregnancy and pregnancy outcomes. ResultsIn 449 women, the age-adjusted incidence of pregnancies decreased from 8.6 before HIV diagnosis to 8.2 and 6.0 per 100 person-years in 0–4 and over 4 years after HIV diagnosis, respectively (P = 0.14). The proportion of induced abortions increased from 42% before to 53% after HIV diagnosis (P < 0.05). The risk of spontaneous abortion did not increase as a result of HIV infection. Since 1995, the proportion of births increased (P = 0.009), whereas that of induced abortions decreased (P = 0.01) compared with earlier years. An increased risk of pregnancy after HIV diagnosis was found in northern and central European women compared with southern European women; there was a lower risk in single women than in women with a steady partner. Of all pregnant women, single women, women between 15 and 25 years of age, and women with multiple partners were at increased risk for induced abortion both before and after HIV diagnosis. ConclusionThe incidence of pregnancy decreased with HIV disease progression. Pregnancies after HIV diagnosis appear to be related largely to social and cultural attitudes. The number of induced abortions was high before HIV diagnosis and it significantly increases thereafter.