Iyun Victoria, Brittain Kirsty, Phillips Tamsin K, le Roux Stanzi, McIntyre James A, Zerbe Allison, Petro Greg, Abrams Elaine J, Myer Landon
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
BMJ Open. 2018 Apr 3;8(4):e019979. doi: 10.1136/bmjopen-2017-019979.
Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission. There are few data investigating how HIV status and use of antiretroviral therapy (ART) may influence pregnancy planning in high HIV burden settings. Our objective was to examine the prevalence and determinants of unplanned pregnancy among HIV-positive and HIV-negative women in Cape Town, South Africa.
Cross-sectional analysis.
Single primary-level antenatal care clinic in Cape Town, South Africa.
HIV-positive and HIV-negative pregnant women, booking for antenatal care from March 2013 to August 2015, were included.
Unplanned pregnancy was measured at the first antenatal care visit using the London Measure of Unplanned Pregnancy (LMUP). Analyses examined LMUP scores across four groups of participants defined by their HIV status, awareness of their HIV status prior to the current pregnancy and/or whether they were using antiretroviral therapy (ART) prior to the current pregnancy.
Among 2105 pregnant women (1512 HIV positive; 593 HIV negative), median age was 28 years, 43% were married/cohabiting and 20% were nulliparous. Levels of unplanned pregnancy were significantly higher in HIV-positive versus HIV-negative women (50% vs 33%, p<0.001); and highest in women who were known HIV positive but not on ART (53%). After adjusting for age, parity and marital status, unplanned pregnancy was most common among women newly diagnosed and women who were known HIV positive but not on ART (compared with HIV-negative women, adjusted OR (aOR): 1.43; 95% CI 1.05 to 1.94 and aOR: 1.57; 95% CI 1.13 to 2.15, respectively). Increased parity and younger age (<24 years) were also associated with unplanned pregnancy (aOR: 1.42; 95% CI 1.25 to 1.60 and aOR: 1.83; 95% CI 1.23 to 2.74, respectively).
We observed high levels of unplanned pregnancy among HIV-positive women, particularly among those not on ART, suggesting ongoing missed opportunities for improved family planning and counselling services for HIV-positive women.
预防意外怀孕是预防母婴传播艾滋病毒的关键环节。在艾滋病毒高负担地区，关于艾滋病毒感染状况和抗逆转录病毒疗法（ART）的使用如何影响怀孕计划的数据很少。我们的目的是调查南非开普敦艾滋病毒阳性和阴性女性中意外怀孕的患病率及决定因素。
横断面分析。
南非开普敦的一家初级产前保健诊所。
纳入了2013年3月至2015年8月前来进行产前保健登记的艾滋病毒阳性和阴性孕妇。
在首次产前检查时，使用伦敦意外怀孕衡量标准（LMUP）来测量意外怀孕情况。分析考察了根据艾滋病毒感染状况、本次怀孕前对自身艾滋病毒感染状况的知晓情况和/或本次怀孕前是否使用抗逆转录病毒疗法（ART）划分的四组参与者的LMUP分数。
在2105名孕妇中（1512名艾滋病毒阳性；593名艾滋病毒阴性），中位年龄为28岁，43%已婚/同居，20%为初产妇。艾滋病毒阳性女性的意外怀孕水平显著高于艾滋病毒阴性女性（50%对33%，p<0.001）；在已知感染艾滋病毒但未接受ART治疗的女性中最高（53%）。在调整年龄、产次和婚姻状况后，意外怀孕在新诊断出感染艾滋病毒的女性以及已知感染艾滋病毒但未接受ART治疗的女性中最为常见（与艾滋病毒阴性女性相比，调整后的比值比（aOR）：1.43；95%置信区间1.05至1.94以及aOR：1.57；95%置信区间1.13至2.15）。产次增加和年龄较小（<24岁）也与意外怀孕有关（aOR分别为：1.42；95%置信区间1.25至1.60以及aOR：1.83；95%置信区间1.23至2.74）。
我们观察到艾滋病毒阳性女性中意外怀孕水平较高，尤其是那些未接受ART治疗的女性，这表明为艾滋病毒阳性女性改善计划生育和咨询服务方面仍存在机会错失的情况。
