Teens with HIV at high risk for pregnancy, complications

Teenage girls and young women infected with HIV get pregnant more often and suffer pregnancy complications more frequently than their HIV-negative peers, according to new research led by Johns Hopkins investigators.

A report on the multicentre study, based on an analysis of records from 181 patients with HIV, ages 13 to 24, treated at four hospitals over 12 years, is published in the Journal of the American Medical Association.

The findings are alarming for at least two reasons, the investigators say. First, teen pregnancies – planned or not – put these already vulnerable patients and their foetuses in grave danger for complications. Second, the findings signal that HIV-infected teens and young women continue to practice unsafe sexual behaviours and to have unprotected sex, the researchers say.

Pregnancy rates were especially high in one subgroup of HIV-infected youth – teens who acquired the virus behaviourally rather than during birth. Behaviourally infected teens had five times the number of pregnancies compared to their HIV-negative counterparts and were more prone to premature births and spontaneous abortions than their HIV-negative peers.

Because of its retrospective nature, the study did not capture why the patients got pregnant. The answer to this question, the researchers say, would supply critical information for future pregnancy-counseling and risk-reduction efforts.

“Our analysis revealed a problem. Now we need to figure out why that is and how we, as providers, can give appropriate counseling and care to these girls and women,” says lead investigator Allison Agwu, MD, ScM, a paediatric infectious disease specialist at the Johns Hopkins Children’s Center.

All HIV-infected patients should be informed about pregnancy risk, including the risk of transmitting HIV to their partners during attempts to become pregnant and to their babies during the pregnancy itself, the researchers say. Therefore, physicians who treat HIV-infected youth should have regular and honest discussion about these risks, they say.

More than one-third (66) of the 181 patients in the study got pregnant, some of whom had more than one pregnancy for a total of 96 pregnancies. Premature births were more common among HIV-infected mothers (34 per cent), compared with mums in the general population (22 per cent) as were spontaneous abortions, 14 per cent among HIV-infected mums compared with 9 per cent among pregnant women in the general population.

Twenty-eight of the 130 teen girls and women infected at birth got pregnant compared with 38 of those 51 who were behaviourally infected. The pregnancy rate of behaviourally infected patients was seven times higher than the rate of those infected at birth, the researchers found. Teen girls and women with behaviourally acquired HIV tended to have repeated pregnancies more often – 37 per cent of them had more than one pregnancy – than their counterparts infected at birth, of whom 14 per cent got pregnant more than once.

Those infected at birth were four times more likely to choose to terminate the pregnancy – 41 per cent of them did so – compared with those who contracted HIV later in life, 10 per cent of whom ended the pregnancy.

Despite the small number of patients involved in the study, the researchers say their analysis shows intriguing differences among youth with HIV, depending on how they got infected in the first place.

“Our findings suggest that teens who were infected with HIV later in life may engage in different sexual behaviours than those infected at birth. Further analysis into these differences will help us find ways to prevent unwanted pregnancies and avoid complications from planned ones,” said senior investigator Kelly Gebo, MD, MPH, a Johns Hopkins infectious disease specialist.

(Source: Johns Hopkins Children’s Center: Journal of the American Medical Association)

More information 

For more information on different types of sexually transmitted infections, prevention of STIs, treatments and effects on fertility, see Sexually transmitted infections (STIs).

For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy.