Birthrate higher for moms with HIV

New study looks at reproductive health trends of women living with the virus

HIV-positive mothers with at least one child give birth to more babies than their HIV-negative peers, a new B.C. study spanning the years from 1997 to 2015 shows.

The analysis of live births published in the medical journal PLOS One shows that among women who have already given birth, HIVpositive mothers have on average more children than a control group of HIV-negative mothers. The trend applies across all ages.

In the study span, there were a total of 669 live births among 270 HIV-positive women aged 15 to 49 and 1,577 births to 871 HIV-negative controls. The birthrate for HIV-positive women aged 15 to 24 was 1.88 live births per woman, while in the HIV-negative control group it was 1.52 per woman.

In the 25- to 34-year-old age group, the birthrate among women living with HIV was 2.62, compared with 1.76 in an HIV-negative control group. And in the 35- to 49-year-old category, the birthrate among HIV-positive mothers was 2.58, versus 2.11 in the HIV-negative group.

The majority of HIV-positive women across Canada are in their reproductive years, and previous research has shown that motherhood is important to them.

There was an average of about 42,700 births annually to all women in the province during the study’s 1997-to-2015 time period. Babies born to HIV-positive women represented 0.05 per cent of all the births over the term of the study.

A study published in 2017 and based on a large group of Canadian women with HIV, showed that nearly a quarter of them between 2013 and 2016 got pregnant, but 60 per cent of such pregnancies were unintended. The new study did not look at whether pregnancies were planned.

There are about 1,200 women and 6,100 men living with HIV in British Columbia.

The Oak Tree Clinic at B.C. Women’s Hospital specializes in care for women and children with HIV, but the study’s authors say females with HIV need access to comprehensive reproductive health care, whether they live in urban areas like Vancouver or rural and remote areas.

Helene Cote, a co-author, and researcher at the Women’s Health Research Institute at B.C. Women’s Hospital, said in an interview that the vast majority (more than 80 per cent) of women living with HIV in Canada are receiving treatment, and most are attaining viral suppression success on such treatment. She said there has never been a baby born in B.C. to a woman aware of her HIV status and on such treatment during her pregnancy.

Cote said the fact that young women with HIV are having more babies would suggest they are conceiving at younger ages because of socio-cultural factors, in addition to feeling secure knowing that while on treatment their risk of transmitting HIV to their baby is “almost zero.”

“Primary care physicians in communities across B.C. must not assume young women are not having unprotected sex. And when they have HIV-positive patients, they must counsel them about sexual and reproductive health, including contraception, pregnancy plans, desires, and risks, among many other things. When a 17-year-old with HIV goes to a doctor and says, ‘I want to get pregnant,’ appropriate health care is required to ensure a safe pregnancy,” she said.

Women account for 18 per cent of all HIV cases in B.C., and since many have been on anti-retroviral treatment for a long time, researchers were keen to learn whether birthrates were going up over time for women in various age groups. Cote said for those aged 25 to 49, they found that as time went on, they did, suggesting women with HIV are “increasingly likely to feel confident about bearing children later in life.”

“The results of this study are an important step toward further understanding the reproductive health trends of women living with HIV, especially now that (they) can have pregnancies with little or no risk of ... transmitting HIV to their child if engaged in care and appropriately treated,” says the study, funded by the Canadian Institutes of Health Research.

Previous research showed associations between HIV infection and lower childbirth rates in lowand middle-income countries, while the latest study is among the few done on women in highincome jurisdictions.