{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:46:32Z","timestamp":1747183592723,"version":"3.40.5"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PCS\u2010161876"],"award-info":[{"award-number":["PCS\u2010161876"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In Canada, as is found globally, women of reproductive age are a growing demographic of persons living with HIV. Combination antiretroviral therapy (cART) treatment enables women living with HIV (WLWH) to become pregnant without perinatal transmission, and they are increasingly planning to become pregnant. Since 2014, Canadian guidelines no longer recommend routine elective cesarean birth (CB) for women who are virally suppressed and receiving cART. It is unknown whether their obstetric care has changed since this update. Our objective was to describe trends in cesarean births among WLWH in Ontario, Canada, over a 12\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our research is co\u2010led and codesigned with WLWH. We conducted a retrospective population\u2010level cohort study using linked health administrative databases at ICES (formally, the Institute for Clinical and Evaluative Sciences). Participants were all women who gave birth in Ontario, between 2006\/07 and 2017\/18. We assessed their intrapartum characteristics and used multivariable regression to determine an association between HIV status and CB, controlling for sociodemographic and clinical variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Since 2014, the overall proportion of CB among WLWH remained stable and was higher than among women without HIV (39.9% vs 29.0%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). In addition, the proportion of primary CB decreased between 2006 and 2010 and between 2014 and 2018 (28.5%\u201019.3%), whereas the proportion of repeat CB increased (13.1%\u201020.5%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.013).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Because of decreasing HIV\u2010related indications for CB, more practitioners may be following the guidelines for first\u2010time mothers. Currently, no guidelines exist for care of WLWH with a previous CB, and opportunities for vaginal birth may be missed in this population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12545","type":"journal-article","created":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T04:15:55Z","timestamp":1616040955000},"page":"357-365","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns of cesarean birth among women living with HIV in Ontario: A cross\u2010sectional, population\u2010level study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4552-4978","authenticated-orcid":false,"given":"Esther S.","family":"Shoemaker","sequence":"first","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"},{"name":"ICES Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tana","family":"Saiyin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Ottawa Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Smith","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Loutfy","sequence":"additional","affiliation":[{"name":"ICES Ottawa ON Canada"},{"name":"Infectious Disease Clinician Scientist Departments of Medicine Women\u2019s College Hospital University of Toronto Toronto ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liz","family":"Darling","sequence":"additional","affiliation":[{"name":"ICES Ottawa ON Canada"},{"name":"Department of Midwifery McMaster University Hamilton ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Newborn Care The Ottawa Hospital Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Hawken","sequence":"additional","affiliation":[{"name":"ICES Ottawa ON Canada"},{"name":"Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jahanara","family":"Begum","sequence":"additional","affiliation":[{"name":"ICES Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Bibeau","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Breklyn","family":"Bertozzi","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Fraleigh","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gladys","family":"Kwaramba","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerrigan","family":"Johnson","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashlee","family":"Cousineau","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire E.","family":"Kendall","sequence":"additional","affiliation":[{"name":"C.T. Lamont Primary Health Care Research Centre Bruy\u00e8re Research Institute Ottawa ON Canada"},{"name":"ICES Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"volume-title":"UNAIDS Data 2019","year":"2019","author":"UNAIDS","key":"e_1_2_7_2_1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.14745\/ccdr.v45i12a01"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0081355"},{"volume-title":"UNAIDS Data 2018","year":"2018","author":"UNSAID","key":"e_1_2_7_5_1"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0007925"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2015-000010"},{"issue":"13","key":"e_1_2_7_8_1","first-page":"1683","article-title":"Canadian consensus guidelines for the management of pregnant HIV\u2010positive women and their offspring on behalf of the Canadian HIV Trials Network Working Group on Vertical HIV Transmission","volume":"168","author":"Burdge DR","year":"2003","journal-title":"CMAJ"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.06.021"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282f9b67a"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1086\/427287"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30515-6"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13509"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000233154.62729.24"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060870"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.18.2411"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000474"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0074848"},{"issue":"6","key":"e_1_2_7_19_1","first-page":"1","article-title":"Complications and route of delivery in a large cohort study of HIV\u20101\u2010infected Women\u2010 IMPAACT","volume":"5","author":"Rutering J","year":"2016","journal-title":"Nat Rev Drug Discov"},{"volume-title":"Population\u2010Specific HIV\/AIDS Status Report: Women","year":"2014","author":"Public Health Agency of Canada","key":"e_1_2_7_20_1"},{"issue":"9","key":"e_1_2_7_21_1","first-page":"730","article-title":"Engagement of people with lived experience in primary care research: living with HIV innovation team community scholar program","volume":"63","author":"Kendall CE","year":"2017","journal-title":"Can Fam Physician"},{"key":"e_1_2_7_22_1","unstructured":"ICES.ICES: data discovery better health.https:\/\/www.ices.on.ca\/. 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