Pregnancy rates among women infected with human immunodeficiency virus

OBJECTIVE: To examine pregnancy rates among women infected with human immunodeficiency virus (HIV). METHODS: We used data from an ongoing survey of medical records of 3915 women who were 15-44 years of age, infected with HIV, and who received care between January 1990 and August 1994 in more than 90 clinics, hospitals, and private practices in 11 United States cities. RESULTS: At enrollment, 570 (14%) of these women were pregnant. Pregnancy rates at entry varied significantly (P < .05) by age in years (15-19 47%, 20-24 30%, 25-29 18%; 30-34 11%; 35-39 5%; 40-44 2%); clinical status (with AIDS opportunistic illness 3%, without AIDS opportunistic illness 17%; and race-ethnicity (white 12%, black 17%, Hispanic 8%, Asian 0%, Native American 30%) but not by mode of exposure (injecting drug use 10%, heterosexual contact 15%, and blood transfusion 12%). After enrollment, 5.8% of women became pregnant each year. New pregnancies were significantly less likely to occur among women with an AIDS opportunistic illness (adjusted rate ratio 0.4, 95% confidence interval CI 0.2-0.6), and significantly more likely to occur among women who were less than 25 years of age (adjusted rate ratio 8.3, 95% CI 5.3-13.2) and who were black (adjusted rate ratio 1.6, 95% CI 1.2-2.1). Among women who were pregnant at enrollment or during observation, 12% were pregnant more than once. CONCLUSIONS: High rates of pregnancy at entry to medical care among HIV-infected women stress the importance of counseling and voluntary testing as routine obstetric-gynecologic practice. In some groups, rates of new pregnancies remain high; standard HIV care for women should include family planning services and assurance that if a woman chooses to practice contraception, contraceptives will be available and affordable.