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Paulsen FW, Tetens MM, Vollmond CV, Gerstoft J, Kronborg G, Johansen IS, Larsen CS, Wiese L, Dalager-Pedersen M, Lunding S, Nielsen LN, Weis N, Obel N, Omland LH, Lebech AM. Incidence of Childbirth, Pregnancy, Spontaneous Abortion, and Induced Abortion Among Women With Human Immunodeficiency Virus in a Nationwide Matched Cohort Study. Clin Infect Dis 2023; 76:1896-1902. [PMID: 36718956 DOI: 10.1093/cid/ciad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Reproductive health in women with human immunodeficiency virus (HIV) (WWH) has improved in recent decades. We aimed to investigate incidences of childbirth, pregnancy, spontaneous abortion, and induced abortion among WWH in a nationwide, population-based, matched cohort study. METHODS We included all WWH aged 20-40 years treated at an HIV healthcare center in Denmark from 1995 to 2021 and a matched comparison cohort of women from the general population (WGP). We calculated incidence rates per 1000 person-years and used Poisson regression to calculate adjusted incidence rate ratios (aIRRs) of childbirth, pregnancy, spontaneous abortion, and induced abortion stratified according to calendar periods (1995-2001, 2002-2008, and 2009-2021). RESULTS We included 1288 WWH and 12 880 WGP; 46% of WWH were of African origin, compared with 1% of WGP. Compared with WGP, WWH had a decreased incidence of childbirth (aIRR, 0.6 [95% confidence interval, .6-.7]), no difference in the incidence of pregnancy (0.9 [.8-1.0]) or spontaneous abortion (0.9 [.8-1.0]), but an increased incidence of induced abortion (1.9 [1.6-2.1]) from 1995 to 2021. The aIRRs for childbirth, pregnancy, and spontaneous abortion increased from 1995-2000 to 2009-2021, while the aIRR for induced abortion remained increased across all time periods for WWH. CONCLUSIONS From 1995 to 2008, the incidences of childbirth, pregnancy, and spontaneous abortion were decreased among WWH compared with WGP. From 2009 to 2021, the incidence of childbirth, pregnancy, and spontaneous abortion no longer differed among WWH compared with WGP. The incidence of induced abortions remains increased compared with WGP.
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Affiliation(s)
- Fie W Paulsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cecilie V Vollmond
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Carsten S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Suzanne Lunding
- Department of Internal Medicine, Copenhagen University Hospital, Herlev, Herlev, Denmark
| | - Lars N Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, North Zealand Hospital, Hillerød, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Van Ommen CE, Albert AYK, Piske M, Money DM, Cote HCF, Lima VD, Maan EJ, Alimenti A, van Schalkwyk J, Pick N, Murray MCM. Exploring the live birth rates of women living with HIV in British Columbia, Canada. PLoS One 2019; 14:e0211434. [PMID: 30726263 PMCID: PMC6364910 DOI: 10.1371/journal.pone.0211434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the birth rates of women living with HIV (WLWH) compared to the general population in British Columbia (BC), Canada. Methods We retrospectively reviewed clinical and population level surveillance data from 1997 to 2015. Live birth rates from 1997 to 2015 among WLWH aged 15–49 years were compared with those of all BC women. Next, the number of live births among WLWH with a live birth between 1997–2012 and HIV-negative controls matched 1:3 by geocode were compared. Results WLWH had a lower birth rate compared to all BC women [31.4 (95%CI, 28.6–34.3) vs. 40.0 (39.3–40.1)/1000 person years]. Stratified by age, WLWH aged 15–24 years had a higher birth rate while WLWH aged 25–49 years had a lower birth rate than BC women (p<0.01). Between 1997 and 2015, birth rates for both populations decreased among women aged 15–24 years, and increased among women aged 25–49 years, most strikingly among WLWH 35–49 years (p<0.01). When comparing WLWH with a live birth to HIV-negative geocode matched controls, WLWH aged 15–24 years (p = 0.03) and aged 25–34 years (p<0.01) had more live births than controls while WLWH aged 35–49 years did not (p = 0.06). Conclusions On a population level, WLWH have lower birth rates than the general population. However, this is not observed among WLWH who have ever given birth compared with matched controls, suggesting that sociodemographic factors may play an important role. WLWH are increasingly giving birth in their later reproductive years. Taken together, our data supports the integration of reproductive health and HIV care.
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Affiliation(s)
- Clara E. Van Ommen
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y. K. Albert
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Micah Piske
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah M. Money
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Hélène C. F. Cote
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Evelyn J. Maan
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Ariane Alimenti
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious and Immunologic Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julianne van Schalkwyk
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
| | - Neora Pick
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C. M. Murray
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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3
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Sania A, Smith ER, Manji K, Duggan C, Masanja H, Kisenge R, Msamanga G, Urassa W, Fawzi W. Neonatal and Infant Mortality Risk Associated with Preterm and Small for Gestational Age Births in Tanzania: Individual Level Pooled Analysis Using the Intergrowth Standard. J Pediatr 2018; 192:66-72.e4. [PMID: 29246361 PMCID: PMC5737788 DOI: 10.1016/j.jpeds.2017.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/20/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the risk of newborn and infant mortality associated with preterm, small for gestational age (SGA), and low birth weight (LBW) stratified by maternal HIV status and the location of birth. STUDY DESIGN We created a prospective cohort by pooling 5 individually randomized trials. We used Cox proportional hazard models to estimate the risk of mortality for SGA defined using the recently published Intergrowth standard, preterm, LBW, and gestational age and size for gestational age categories (preterm- appropriate for gestational age [AGA], term-SGA, and preterm-SGA). Effect modification by maternal HIV status and place of residence was assessed using the likelihood ratio test. RESULTS Of the 31 988 infants, 15.3% were preterm, 16.6% were SGA, and 7.3% were LBW. The proportion of preterm and SGA births was higher among the HIV-infected cohort than in the uninfected cohort. Compared with term-AGA groups, infants born both preterm and SGA had a greater risk of neonatal mortality (hazard ratio [HR] 5.43, 95% CI 2.01-14.63) than preterm-AGA infants (HR 2.40, 95% CI 1.89-3.05) and term-SGA infants (HR 2.56, 95% CI 1.96-3.34). Maternal HIV infection modified the risk of infant mortality associated with being born preterm or LBW, with a higher relative risk among those born to HIV-uninfected women. Rural residence significantly modified the risk of neonatal mortality associated with being LBW (P for interaction = .005). CONCLUSIONS Preterm and SGA newborns had an increased risk of mortality during the first year of life. Interventions targeting these conditions, especially in HIV-exposed and rural populations, should be integrated into existing maternal and child health programs.
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Affiliation(s)
- Ayesha Sania
- ICAP, Columbia University, Mailman School of Public Health, New York, NY
| | - Emily R Smith
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
| | - Karim Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher Duggan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Rodrick Kisenge
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gernard Msamanga
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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4
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Sania A, Brittain K, Phillips TK, Zerbe A, Ronan A, Myer L, Abrams EJ. Effect of alcohol consumption and psychosocial stressors on preterm and small-for-gestational-age births in HIV-infected women in South Africa: a cohort study. BMJ Open 2017; 7:e014293. [PMID: 28320796 PMCID: PMC5372146 DOI: 10.1136/bmjopen-2016-014293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Psychosocial stressors such as depression and stress, intimate partner violence (IPV) and alcohol use have been linked to preterm and small-for-gestational-age (SGA) births in general populations. The prevalence of psychosocial stressors and alcohol abuse is high in many HIV-infected (HIV+) populations. Our objective was to evaluate the effects of psychosocial stressors and alcohol abuse on birth outcomes in HIV-infected women. METHODS Antenatal depression and non-specific psychological distress, periconception IPV and alcohol consumption were measured during the second trimester among HIV+ women initiating antiretroviral treatment with efavirenz + emtricitibine + tenofovir in Cape Town, South Africa. Log binomial regression models were used to estimate the risk ratios (RR) and 95% CIs of the effects of psychosocial stressors and periconception alcohol consumption on birth outcomes: SGA (birth weight <10th centile for gestational age) and preterm (<37 weeks) births. RESULTS Of the 571 mother-infant pairs, 26% of women reported hazardous alcohol consumption (Alcohol Use Disorders Identification Test-C score ≥3) periconception periods, 11% reported depressive symptoms, 7% reported non-specific psychological distress and 15% reported experiencing physical or psychological IPV. 14% of infants were born preterm and 12% were SGA. Infants born to women reporting hazardous drinking were twice (adjusted RR 2.00 (95% CI 1.13 to 3.54)) as likely to be SGA compared with women reporting low alcohol intake. Alcohol consumption did not have a significant effect on the incidence of preterm birth. Depressive symptoms, non-specific psychological distress, physical and psychological IPV did not increase the risk of SGA or preterm birth significantly. CONCLUSIONS The observed elevated risk of SGA births associated with periconception alcohol consumption underscores the urgent need to reduce alcohol consumption among women of childbearing age. Interventions targeting modifiable risk factors of adverse birth outcomes need to be integrated into HIV prevention and maternal child health programmes to improve the long-term health of HIV-exposed children. TRIAL REGISTRATION NUMBER NCT01933477; Pre-results.
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Affiliation(s)
- Ayesha Sania
- ICAP, Columbia University, Mailman School of Public Health, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, USA
| | - Agnes Ronan
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centrefor Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, USA
- College of Physicians and Surgeons, Columbia University, New York, USA
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5
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Buchan S, Muldoon KA, Spaans JN, Balfour L, Samson L, Walker M, Cameron DW. Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2016; 2016:1546365. [PMID: 27528877 PMCID: PMC4978822 DOI: 10.1155/2016/1546365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/28/2016] [Accepted: 05/16/2016] [Indexed: 11/18/2022]
Abstract
Background. The prevalence and associated risks with adverse obstetrical outcomes among women living with HIV are not well measured. The objective of this study was to longitudinally investigate the prevalence and correlates of adverse obstetrical outcomes among women with HIV. Methods. This 20-year (1990-2010) clinical case series assessed the prevalence of adverse obstetrical outcomes among pregnant women with HIV receiving care at The Ottawa Hospital (TOH). General estimating equation modeling was used to identify factors independently associated with adverse obstetrical outcomes, while controlling for year of childbirth clustering. Results. At TOH, there were 127 deliveries among 94 women (1990-2010): 22 preterm births, 9 births with low birth weight, 12 births small for gestational age, and 4 stillbirths. Per year, the odds of adverse obstetrical outcomes increased by 15% (OR: 1.15, 95% CI: 1.03-1.30). Psychiatric illness (AOR: 2.64, 95% CI: 1.12-6.24), teen pregnancy (AOR: 3.35, 95% CI: 1.04-1.46), and recent immigrant status (AOR: 7.24, 95% CI: 1.30-40.28) were the strongest correlates of adverse obstetrical outcomes. Conclusions. The increasing number and proportion of adverse obstetrical outcomes among pregnant women with HIV over the past 20 years highlight the need for social supports and maternal and child health interventions, especially among adolescents, new immigrants, and those with a history of mental illness.
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Affiliation(s)
- Sarah Buchan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- Department of Medicine, Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
| | - Katherine A. Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- School of Epidemiology, Public Health and Presentation Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6
| | - Johanna N. Spaans
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
| | - Louise Balfour
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- Department of Medicine, Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
| | - Lindy Samson
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada K1H 8L1
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- School of Epidemiology, Public Health and Presentation Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6
- Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
| | - D. William Cameron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- Department of Medicine, Division of Infectious Disease, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
- School of Epidemiology, Public Health and Presentation Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6
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6
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Ng R, Kendall CE, Burchell AN, Bayoumi AM, Loutfy MR, Raboud J, Glazier RH, Rourke S, Antoniou T. Emergency department use by people with HIV in Ontario: a population-based cohort study. CMAJ Open 2016; 4:E240-8. [PMID: 27398370 PMCID: PMC4933601 DOI: 10.9778/cmajo.20150087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Emergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV. METHODS We conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used random-effects negative binomial regression to compare rates of emergency department use. We classified visits as low urgency or high urgency, and also examined visits for ambulatory care sensitive conditions. Hospital admission following an emergency department visit was a secondary outcome. RESULTS We identified 14 534 people with HIV and 58 136 HIV-negative individuals. Rates of emergency department use were higher among people with HIV (67.3 v. 31.2 visits per 100 person-years; adjusted rate ratio 1.58, 95% confidence interval [CI] 1.51-1.65). Similar results were observed for low-urgency visits. With the exception of hypertension, visit rates for ambulatory care sensitive conditions were higher among people with HIV. People with HIV were also more likely than HIV-negative individuals to be admitted to hospital following an emergency department visit (adjusted odds ratio 1.55, 95% CI 1.43-1.69). INTERPRETATION Compared with HIV-negative individuals, people with HIV had high rates of emergency department use, including potentially avoidable visits. These findings strongly support the need for comprehensive care for people with HIV.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Claire E Kendall
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Ann N Burchell
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Sean Rourke
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont
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7
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Macdonald EM, Ng R, Yudin MH, Bayoumi AM, Loutfy M, Raboud J, Masinde KI, Tharao WE, Brophy J, Glazier RH, Antoniou T. Postpartum Maternal and Neonatal Hospitalizations Among Women with HIV: A Population-Based Study. AIDS Res Hum Retroviruses 2015; 31:967-72. [PMID: 26132654 PMCID: PMC4576941 DOI: 10.1089/aid.2015.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Postpartum maternal and neonatal readmissions in the period shortly following birth are indicators of serious morbidity. We compared the risk of postpartum maternal and neonatal hospitalizations in women living with and without HIV in Ontario, Canada. We conducted a population-based study of pregnancies in Ontario between April 1, 2002 and March 31, 2011 using Ontario's administrative health care databases. Generalized estimating equations were used to derive adjusted odds ratios (aORs) and 95% confidence intervals (CI) for the association of HIV infection with postpartum maternal hospitalizations within 30 days of hospital discharge and neonatal hospitalizations within 30 and 60 days of hospital discharge. Between 2002/2003 and 2010/2011, 1,133,505 pregnancies were available for analysis, of which 634 (0.06%) were to women living with HIV. The proportion of postpartum maternal hospitalizations (2.8% versus 1.1%; odds ratio 2.53; 95% CI 1.57 to 4.07) was higher among women with HIV. The multivariable adjusted odds ratio was 1.54 (95% CI 0.93 to 2.55). The proportions of neonates hospitalized within 30 (2.6% versus 3.7%; aOR 0.68, 95% CI 0.42 to 1.10) and 60 days (4.9% versus 4.9%; aOR 0.86, 95% CI 0.60 to 1.24) of discharge were similar among infants born to women with and without HIV. Women living with HIV are at a higher risk of postpartum maternal hospitalizations than women not living with HIV. The effect of HIV infection was attenuated by multivariable adjustment, suggesting that sociodemographic or health care factors are responsible for much of the difference in outcomes.
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Affiliation(s)
- Erin M. Macdonald
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mark H. Yudin
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M. Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario Canada
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Wangari E. Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada
| | - Jason Brophy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Richard H. Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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8
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Macdonald EM, Ng R, Bayoumi AM, Raboud J, Brophy J, Masinde KI, Tharao WE, Yudin MH, Loutfy MR, Glazier RH, Antoniou T. Adverse Neonatal Outcomes Among Women Living With HIV: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:302-309. [PMID: 26001682 DOI: 10.1016/s1701-2163(15)30279-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There have been few population-based studies describing the risk of adverse neonatal outcomes among women living with HIV in Canada. Accordingly, we compared the risk of preterm birth (PTB), low birth weight (LBW) and small for gestational age births among Ontario women aged 18 to 49 years living with and without HIV infection. METHODS We conducted a population-based study using Ontario health administrative data. Generalized estimating equations with a logit link function were used to derive adjusted odds ratios (aORs) and 95% confidence intervals for the association of HIV infection with adverse neonatal outcomes. RESULTS Between 2002-2003 and 2010-2011, a total of 1 113 874 singleton live births were available for analysis, of which 615 (0.06%) were to women living with HIV. The proportion of singleton births that were SGA (14.6% vs. 10.3%; P < 0.001), PTB (14.6% vs. 6.3%; P < 0.001), and LBW (12.5% vs. 4.6%; P < 0.001) were higher among women living with HIV than among women without HIV. Following multivariable adjustment, the risks of PTB (aOR 1.76; 95% CI 1.38 to 2.24), SGA (aOR 1.43; 95% CI 1.12 to 1.81), and LBW (aOR 1.90; 95% CI 1.47 to 2.45) were higher for women living with HIV than for women without HIV. CONCLUSION Women with HIV are at higher risk of adverse neonatal outcomes than HIV-negative women. Further research is required to develop preconception and prenatal interventions that could reduce the excess burden of poor pregnancy outcomes among women living with HIV.
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Affiliation(s)
| | - Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto ON
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Department of Medicine, University of Toronto, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto ON; Toronto General Research institute, University Health Network, Toronto ON; Dalla Lana School of Public Health, University of Toronto, Toronto ON
| | - Jason Brophy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa ON
| | | | - Wangari E Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto ON
| | - Mark H Yudin
- Li Ka Shing Knowledge institute, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON; Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto ON
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Department of Medicine, University of Toronto, Toronto ON; Women's College Research institute, Women's College Hospital, Toronto ON
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto ON; Centre for Research on inner City Health, St. Michael's Hospital, Toronto ON; Dalla Lana School of Public Health, University of Toronto, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto ON
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto ON; Li Ka Shing Knowledge institute, Toronto ON; Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto ON; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON
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9
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Kakkar F, Boucoiran I, Lamarre V, Ducruet T, Amre D, Soudeyns H, Lapointe N, Boucher M. Risk factors for pre-term birth in a Canadian cohort of HIV-positive women: role of ritonavir boosting? J Int AIDS Soc 2015; 18:19933. [PMID: 26051165 PMCID: PMC4458515 DOI: 10.7448/ias.18.1.19933] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/12/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The risk of pre-term birth (PTB) associated with the use of protease inhibitors (PIs) during pregnancy remains a subject of debate. Recent data suggest that ritonavir boosting of PIs may play a specific role in the initiation of PTB, through an effect on the maternal-fetal adrenal axis. The primary objective of this study is to compare the risk of PTB among women treated with boosted PI versus non-boosted PIs during pregnancy. METHODS Between 1988 and 2011, 705 HIV-positive women were enrolled into the Centre Maternel et Infantile sur le SIDA mother-infant cohort at Centre Hospitalier Universitaire Sainte-Justine in Montreal, Canada. Inclusion criteria for the study were: 1) attendance at a minimum of two antenatal obstetric visits and 2) singleton live birth, at 24 weeks gestational or older. The association between PTB (defined as delivery at <37 weeks gestational age), antiretroviral drug exposure and maternal risk factors was assessed retrospectively using logistic regression. RESULTS A total of 525 mother-infant pairs were included in the analysis. Among them, PI-based combination anti-retroviral therapy was used in 37.4%, boosted PI based in 24.4%, non-nucleoside reverse transcriptase inhibitor (NNRTI) or nucleoside reverse transcriptase inhibitor based in 28.1%, and no treatment was given in 10.0% of cases. Overall, 13.5% of women experienced PTB. Among women treated with antiretroviral therapy, the risk of PTB was significantly higher among women who received boosted versus non-boosted PI (OR 2.01, 95% CI 1.02-3.97). This remained significant after adjusting for maternal age, delivery CD4 count, hepatitis C co-infection, history of previous PTB, and parity (aOR 2.17, 95% CI 1.05-4.51). There was no increased risk of PTB with the use of unboosted PIs as compared to NNRTI- or NRTI-based regimens. CONCLUSION While previous studies on the association between PTB and PI use have generally considered all PIs the same, our results would indicate a possible role of ritonavir boosting as a risk factor for PTB. Further work is needed to understand the pathophysiologic mechanisms involved, and to identify the safest ARV regimens to be used in pregnancy.
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Affiliation(s)
- Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montréal, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre maternel et infantile sur le SIDA, CHU Sainte-Justine, Montreal, Canada;
| | - Isabelle Boucoiran
- Centre maternel et infantile sur le SIDA, CHU Sainte-Justine, Montreal, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, CHU Sainte-Justine, Montreal, Canada
| | - Valerie Lamarre
- Division of Infectious Diseases, CHU Sainte-Justine, Montréal, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre maternel et infantile sur le SIDA, CHU Sainte-Justine, Montreal, Canada
| | - Thierry Ducruet
- Unité de recherche clinique appliquée, CHU Sainte-Justine, Montréal, Canada
| | - Devendra Amre
- Centre de recherche du CHU Sainte-Justine, Montréal, Canada
| | - Hugo Soudeyns
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de recherche du CHU Sainte-Justine, Montréal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Normand Lapointe
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre maternel et infantile sur le SIDA, CHU Sainte-Justine, Montreal, Canada
| | - Marc Boucher
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre maternel et infantile sur le SIDA, CHU Sainte-Justine, Montreal, Canada
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Ng R, Macdonald EM, Loutfy MR, Yudin MH, Raboud J, Masinde KI, Bayoumi AM, Tharao WE, Brophy J, Glazier RH, Antoniou T. Adequacy of prenatal care among women living with human immunodeficiency virus: a population-based study. BMC Public Health 2015; 15:514. [PMID: 26058544 PMCID: PMC4462120 DOI: 10.1186/s12889-015-1842-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 05/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Prenatal care reduces perinatal morbidity. However, there are no population-based studies examining the adequacy of prenatal care among women living with HIV. Accordingly, we compared the prevalence of adequate prenatal care among women living with and without HIV infection in Ontario, Canada. Methods Using administrative data in a universal single-payer setting, we determined the proportions of women initiating care in the first trimester and receiving adequate prenatal care according to the Revised-Graduated Prenatal Care Utilization Index . We also determined the proportion of women with HIV receiving adequate prenatal care by immigration status. We used generalized estimating equations with a logit link function to derive adjusted odds ratios (aORs) and 95 % confidence intervals (CI) for all analyses. Results Between April 1, 2002 and March 31, 2011, a total of 1,132,135 pregnancies were available for analysis, of which 634 (0.06 %) were among women living with HIV. Following multivariable adjustment, women living with HIV were less likely to receive adequate prenatal care (36.1 % versus 43.3 %; aOR 0.74, 95 % CI 0.62 to 0.88) or initiate prenatal care in the first trimester (50.8 % versus 70.0 %; aOR 0.51, 95 % CI 0.43 to 0.60) than women without HIV. Among women with HIV, recent (i.e. ≤ 5 years) immigrants from Africa and the Caribbean were less likely to receive adequate prenatal care (25.5 % versus 38.5 %; adjusted odds ratio 0.51; 95 % CI, 0.32 to 0.81) than Canadian-born women. Conclusion Despite universal health care, disparities exist in the receipt of adequate prenatal care between women living with and without HIV. Interventions are required to ensure that women with HIV receive timely and adequate prenatal care. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1842-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryan Ng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Erin M Macdonald
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Mona R Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Mark H Yudin
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. .,Department of Obstetrics and Gynecology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
| | - Janet Raboud
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Wangari E Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada.
| | - Jason Brophy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
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