Background: Women with human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) have increased risk for adverse pregnancy outcomes. Rates of alcohol and tobacco use are high among adults with these diseases and may compound the associated health risks. Women with chronic infectious diseases should receive thorough prenatal care to mitigate health risks and encourage health promoting behaviors. Our objective was to compare pregnancy-related health behaviors between women with and without chronic infectious diseases.
Methods: A retrospective cohort study was performed using the Colorado birth registry from 2007-2014. Level of prenatal care, smoking and drinking during pregnancy, infant receipt of hepatitis B vaccine at birth, and delivery in a hospital were compared between women with HIV, HBV, or HCV and women without one of these diseases. Records were excluded for missing data, non-singleton births, and multiple births in the study period. Univariable and multivariable logistic regression were used to compare each outcome between women with chronic infectious diseases and women without. Multivariable analyses considered maternal age, education, income, race and ethnicity as potential covariates.
Results: The cohort included 316,515 women. Of these, 1244 (0.39%) had a chronic infectious disease, including 143 with HIV, 606 with HBV, and 542 with HCV. Women with HIV, HBV, or HCV were less likely to receive intensive or adequate prenatal care [51% vs 65%; adjusted odds ratio (aOR) 0.73, 95% CI 0.65-0.82] and more likely to smoke (23% vs 9%; aOR 2.41, 95% CI 2.07-2.80) or drink (3% vs 1%; aOR 2.21, 95% CI 1.54-3.17) during pregnancy. Infants of women with HIV or HCV were more likely to receive hepatitis B vaccine at birth (77% vs 69%; aOR 1.22, 95% CI 1.01-1.49). Almost all women delivered in a hospital including 99% of women with chronic infectious diseases and 98% of those without (aOR 1.01; 95% CI 0.58-1.76).
Conclusion: Although they are at higher risk for complications, pregnant women with chronic infectious diseases are less likely to receive appropriate prenatal care and more likely to engage in high-risk behaviors. Interventions are needed to improve prenatal care and health-promoting behaviors among women with HIV, HBV, and HCV.