Adequacy of Prenatal Care Among Women Living With HIV in Colorado

Background: Adequate prenatal care is crucial for pregnant women living with human immunodeficiency virus (HIV). Women with HIV achieve better perinatal and birth outcomes when they receive adequate prenatal care. Social and economic factors may contribute to accessing prenatal care, and may disproportionately affect people with HIV. The adequacy of prenatal care among women living with HIV in Colorado has not been evaluated. The objectives of this study were to determine the adequacy of prenatal care among women with HIV in Colorado, and to identify socioeconomic factors associated with adequate prenatal care in this population.

Methods: We conducted a retrospective cohort study using data from the Colorado Birth Certificate database, from 2007 to 2014. Multivariable logistic regression analysis was used to examine the association between HIV status and adequacy of prenatal care based on categories derived from the Graduated Index of Prenatal Care Utilization (GINDEX), adjusted for maternal age, race, ethnicity, marital status, immigrant status, annual household income, and educational level. We also sought to identify factors associated with adequate prenatal care among women living with HIV.

Results: The analysis included 438,897 women without HIV and 204 women with HIV. Women with HIV were 42% less likely to receive adequate prenatal care compared to women without HIV (unadjusted OR 0.58; 95% CI: 0.44, 0.77; p = 0.0001); this association was not statistically significant after adjusting for potential confounders (adjusted OR 0.84; 95% CI 0.63, 1.12; p = 0.2309). Among women with HIV, annual household income >$50,000 was associated with receipt of adequate prenatal care (OR 5.31; 95% CI: 1.73, 16.32; p = 0.0067).

Conclusion: Women living with HIV in Colorado were less likely to receive adequate prenatal care than women without HIV; however, this disparity was mitigated by demographic confounders. For women with HIV, low income may be a barrier to accessing adequate prenatal care; outreach efforts may wish to target this high-risk subgroup. Further research may include qualitative studies to evaluate other facilitators and barriers to accessing prenatal services, as well as the quality of prenatal care received.