Induced abortions of women living with HIV in Finland 1987-2019: a national register study

Mikaela Mutru; Pia Kivelä; Jukka Ollgren; Kirsi Liitsola; Mika Gissler; Inka Aho

doi:10.1186/s12884-023-05430-x

Induced abortions of women living with HIV in Finland 1987-2019: a national register study

BMC Pregnancy Childbirth. 2023 Feb 18;23(1):120. doi: 10.1186/s12884-023-05430-x.

Authors

Mikaela Mutru^{1

2

3}, Pia Kivelä^{4

5

6}, Jukka Ollgren⁶, Kirsi Liitsola⁶, Mika Gissler^{6

7

8}, Inka Aho^{4

5}

Affiliations

¹ University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland. mikaela.mutru@helsinki.fi.
² Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland. mikaela.mutru@helsinki.fi.
³ Finnish Institute for Health and Welfare, Helsinki, Finland. mikaela.mutru@helsinki.fi.
⁴ University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland.
⁵ Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland.
⁶ Finnish Institute for Health and Welfare, Helsinki, Finland.
⁷ Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
⁸ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Abstract

Background: Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987-2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented.

Methods: A retrospective nationwide register study of all WLWH in Finland 1987-2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland.

Results: Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987-1997 to 2009-2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998-2019 were being foreign-born (OR 3.09, 95% CI 1.55-6.19), younger age (OR 0.95 per year, 95% CI 0.90-1.00), previous induced abortions (OR 3.36, 95% CI 1.80-6.28), and previous deliveries (OR 2.13, 95% CI 1.08-4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008-0.029%.

Conclusions: Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.

Keywords: HIV infections; HIV testing; Induced abortion; Registries; Retrospective studies.

MeSH terms

Abortion, Induced*
Abortion, Spontaneous* / epidemiology
Female
Finland / epidemiology
Humans
Pregnancy
Registries
Retrospective Studies