Significant rates of unplanned pregnancies among young women born with HIV

Winnie Sseruma, HIV i-Base

There is little research and information reported on young women growing up with HIV. But a study at the meeting showed some interesting data on the pregnancy outcomes of young women who were born with HIV 10–20 years ago. The study looked at a cohort of 172 women, born with HIV and accessing services in 19 centres across the UK and Ireland.

Overall, there were 36 pregnancies reported in 27 women, with a median age of 18 years at first pregnancy. Of these, 27 (75%) were unplanned, 7 (19%) were planned and 2 were unknown. The women all conceived before September 2009. Seventeen women were on HAART, with a median CD4 count of 244 cells/mm3, but 8 out of the10 women who were not on treatment had CD4 counts below 200 cells/mm3.

Of the reported pregnancies, 86% (31/36) were with regular partners, of whom 22 (61%) reported being unaware of their partners HIV status. The pregnancies resulted in 5 (14%) 1st trimester miscarriages, 9 (25%) elective terminations, 18 (50%) live births and 4 (11%) pregnancies were ongoing.

At the time of delivery, 89% of the mothers were on HAART, with a median CD4 count of 254 cells/mm3 and a median viral load of 79 copies/mL (range <50–580,000). Seven women delivered with viral load <50 copies/mL, four had VL >1,000 copies/mL. Two women were admitted for Directly Observed Therapy and two were non-adherent to HAART at delivery. Mode of delivery was 9 elective and 5 emergency C-sections with 4 vaginal deliveries. 6 (33%) infants delivered at <37/40, five of whom required Neonatal Intensive Care. None of the babies were infected and there were no congenital anomalies were reported. Five of the babies were fostered and 3 have ongoing concerns.

The study showed without a doubt, that prevention of mother to child transmission worked, even though some mothers had advanced HIV and were not well adherent. Additionally, the study also highlighted a worrying high number of unplanned pregnancies, a population with social needs despite access to contraceptive services.

Ref: Williams B et al.  Pregnancy outcomes in women growing up with HIV acquired perinatally or in early childhood. 2nd Joint Conference of BHIVA with BASHH, 20–23 April 2010, Manchester. Poster abstract P144.

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