Abstract
BackgroundThe success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum.MethodsIn a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019–2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum.ResultsA total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis.ConclusionsA high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.
Highlights
The success of antiretroviral therapy has normalized pregnancy among women living with human immunodeficiency virus (HIV) (WWH) with a very low risk of perinatal transmission of HIV
The success of combination antiretroviral therapy has resulted in a dramatic decrease in perinatal transmission of human immunodeficiency virus (HIV) to less than 1% in most Western countries, in addition to a normalization of pregnancy [1, 2]. This has resulted in an increase in the annual number of HIV pregnancies, both internationally and in Nordic countries [1, 3, 4]. Despite these advancements, women living with HIV (WWH) still face complex psychosocial and medical issues during pregnancy, childbirth, and postpartum [5, 6]
Using quantitative data from the 2BMOM Study, a multicentre longitudinal mixed methods study among pregnant WWH, non-pregnant WWH, and pregnant women without HIV (WWOH) in the Nordic countries Denmark, Finland, and Sweden [27], we aim to explore psychosocial health outcomes of WWH across the pregnancy–postpartum trajectory, assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH and pregnant WWOH, and identify factors associated with depression in the third trimester and postpartum for WWH and WWOH
Summary
The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The success of combination antiretroviral therapy (cART) has resulted in a dramatic decrease in perinatal transmission of human immunodeficiency virus (HIV) to less than 1% in most Western countries, in addition to a normalization of pregnancy [1, 2] This has resulted in an increase in the annual number of HIV pregnancies, both internationally and in Nordic countries [1, 3, 4]. In addition to the usual stresses of new motherhood, WWH must cope with stressors that include their own health, the unknown infectious states of their infants, and attending to their infantsunique needs such as the administration of prophylactic antiretroviral medication [6, 11]
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