Abstract
Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.
Highlights
Access to preconception care (PCC) aimed at promoting pregnancy planning, reducing unintended pregnancies, optimizing maternal health prior to pregnancy, and using safer conception strategies is needed to optimize health outcomes for HIV-infected women and their infants, reduce adverse pregnancy outcomes, and strengthen prevention efforts for at-risk partners and children
This paper will discuss the rationale for preconception counseling and care in the setting of HIV and review current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on wellresourced settings and on elements of PCC that are specific to women living with HIV
PCC, which includes contraceptive care, is an important component of primary health care services for all women living with HIV with the potential for childbearing
Summary
Access to preconception care (PCC) aimed at promoting pregnancy planning, reducing unintended pregnancies, optimizing maternal health prior to pregnancy, and using safer conception strategies is needed to optimize health outcomes for HIV-infected women and their infants, reduce adverse pregnancy outcomes, and strengthen prevention efforts for at-risk partners and children. Benefits of PCC in identifying and modifying risks to maternal health and pregnancy outcomes and in preventing unwanted pregnancies are well documented [1,2,3]. The American College of Obstetricians and Gynecologists (ACOG) and the Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission in the United States and other national organizations recommend offering all HIV-infected women of childbearing age comprehensive family planning and the opportunity to receive preconception counseling and care as a component of routine primary medical care [2, 4]. This paper will discuss the rationale for preconception counseling and care in the setting of HIV and review current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on wellresourced settings and on elements of PCC that are specific to women living with HIV
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