Research Article
Preconception Counseling and Care in the Setting of HIV:
Clinical Characteristics and Comorbidities
Rupsa C. Boelig,
1
Jenell S. Coleman,
2
Jean Keller,
2
Catherine Sewell,
2,3
and Jean Anderson
2
1
Department of Obstetrics & Gynecology, homas Jeferson University Hospital, Philadelphia, PA 19107, USA
2
Division of Gynecologic Specialties, Department of Obstetrics & Gynecology, Johns Hopkins University School of Medicine, Baltimore,
MD 21287, USA
3
Food and Drug Administration, U.S. Department of Health and Human Services, Silver Spring, MD 20993, USA
Correspondence should be addressed to Jenell S. Coleman; colemanj@jhmi.edu
Received 3 November 2014; Accepted 19 February 2015
Academic Editor: Per Anders Mardh
Copyright © 2015 Rupsa C. Boelig et al. his is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. To describe the demographic and clinical characteristics of HIV-infected individuals and HIV-afected couples who
were referred for preconception counseling (PCC) at a large urban US-based HIV clinic. Methods. Electronic medical records were
reviewed for HIV-infected individuals and HIV-afected couples. Medical, reproductive, surgical, psychosocial, and family history
data were abstracted. Univariate analyses were done. Results. here were 8 single HIV-infected women and 100 HIV-afected couples
who underwent PCC. HIV-infected women were older (mean age 35 years versus 32 years, = 0.06), were more likely to smoke
(23% versus 0%, < 0.01), and had more medical comorbidities (57% versus 33%, = 0.04) than HIV-uninfected women.
he majority of couples were serodiscordant (77%), and of these couples, 32% had a detectable plasma viral load and 33% report
inconsistent condom use. Conclusions. HIV-infected women have a number of medical and psychosocial issues, including those
related to HIV that may increase the risk of adverse pregnancy outcomes and HIV perinatal and sexual transmission. PCC is an
important intervention to optimize maternal management to improve perinatal outcomes and minimize transmission risks.
1. Introduction
Advances in HIV treatment and reductions in perinatal
HIV transmission have led to improved quality of life and
increased pregnancies among women with HIV [1]. Studies
conducted in the era of efective antiretroviral treatment
(ART) suggest that HIV-infected women have similar repro-
ductive desires and intentions as HIV-uninfected women [2–
4]. Nevertheless, many pregnancies that occur in the setting
of HIV are unintended and the most efective forms of
reversible contraception are underused [5–8].
Preconception counseling and care (PCC) are associated
with improved maternal and fetal outcomes by identifying
and modifying risks prior to pregnancy and in preventing
unwanted pregnancies [9, 10]. he American College of
Obstetricians and Gynecologists and the United States (U.S.)
Public Health Services Panel on Treatment of HIV-Infected
Pregnant Women and Prevention of Perinatal Transmission
recommend ofering all HIV-infected women of childbearing
age comprehensive PCC as a component of routine primary
medical care [11, 12]. he goal of PCC in the setting of HIV
is to help HIV-infected individuals and HIV-afected couples
make informed reproductive decisions, optimize maternal
and paternal health prior to pregnancy, improve pregnancy
outcomes, and minimize the risk of vertical and/or horizontal
transmission.
Given the lack of data in the literature regarding the
clinical characteristics of individuals presenting for PCC in
the setting of HIV, we sought to describe the demographic
and clinical characteristics of HIV-infected individuals and
HIV-afected couples who were referred for PCC at a large
urban US-based HIV clinic.
2. Materials and Methods
We conducted a retrospective review of electronic medical
records of HIV-infected individuals and HIV-afected cou-
ples, where at least one of the partners was HIV infected. A
convenience sample of patients referred for PCC at the HIV
Hindawi Publishing Corporation
Infectious Diseases in Obstetrics and Gynecology
Volume 2015, Article ID 240613, 6 pages
http://dx.doi.org/10.1155/2015/240613