Grilo Stephanie Ann, Song Xiaoyu, Lutalo Tom, Mullinax Margo, Mathur Sanyukta, Santelli John
Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA.
Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
BMC Womens Health. 2018 Feb 27;18(1):46. doi: 10.1186/s12905-018-0535-y.
Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART).
Data are from the Rakai Community Cohort Study (RCCS) - a cohort of communities with 10,000-12,000 adults, ages 15-49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years.
The prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65-3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002].
HIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.
意外怀孕是一个长期存在的全球性问题，会对母亲和婴儿的健康与福祉产生影响。本文旨在探讨在人类免疫缺陷病毒（HIV）感染率较高且抗逆转录病毒疗法（ART）可及性不断提高的背景下，意外怀孕情况随时间的变化。
数据来自拉凯社区队列研究（RCCS）——乌干达拉凯区一个包含10000 - 12000名15 - 49岁成年人的社区队列。我们研究了不同时间点的当前怀孕率、计划内怀孕和意外怀孕情况（意外怀孕包括意外受孕、时机不当受孕、矛盾受孕）。然后，我们研究了当前怀孕女性中不同类型意外怀孕的风险因素。完整样本涵盖13年期间的32205次观察。
时机不当受孕和意外受孕的发生率均随时间显著下降（p < 0.001）。当前怀孕率和计划内怀孕率在这13年期间没有显著变化。在仅研究样本中的HIV阳性女性时，也发现了相同的总体模式；然而，这些趋势并不显著。在报告的2820例当前怀孕案例中，54.4%是计划内的，29.8%是时机不当的，13.2%是意外受孕，2.5%是矛盾受孕。在控制了其他预测因素后，HIV感染状况对时机不当受孕没有独立影响，但对意外受孕有显著影响（相对风险比RRR = 2.44，95%置信区间CI = 1.65 - 3.61，p < 0.001）以及对矛盾受孕有显著影响（RRR = 2.07；CI：1.03至4.18，p = 0.041）。2004年，在引入抗逆转录病毒疗法后，意外怀孕风险降低[相对风险RR = 0.75；CI：0.66至0.84，p < 0.001]。接受过中等及以上教育的女性意外怀孕风险也有所降低[RR = 0.70；CI：0.70至0.92，p = 0.002]。
HIV是意外受孕的一个重要预测因素。随着时间推移，样本中的意外怀孕情况有所减少，这可能归因于抗逆转录病毒疗法可及性的提高和教育水平的提升。
