Background:  Most women with HIV worldwide are infected during their reproductive years, a time of decision-making about family planning, particularly with increased access to ART. We were interested in studying risk factors of recurrent pregnancy and how to best give recommendations in this area.

Methods:  The MTCT-Plus Initiative enrolled women at pregnancy and after delivery along with their male partners and exposed children. Multidisciplinary team staff assessed family planning methods used at every clinic visit and free condoms were provided. Data on age, ART, CD4 counts, family planning, husband’s HIV status, disclosure, number of children, and time since the last delivery were retrieved from case records of women post-partum.

Results:  There were 557 post-partum women, of whom 36.6% had HIV-infected partners, 29.3% had seronegative partners, and 34.1% had partners with unknown status or reported no partners. There were 18 (3.2%) recurrent pregnancies:  only 3 of these (16.7%) had CD4 count <200 cells/mm³ and 9 (50.0%) were on ART. Last family planning methods reported were condom only (7), tubal resection with condom (1), oral contraceptives only (1), oral contraceptives with condom (2), injection or implantation with condom (1), and natural rhythm (6). Among 11 (61.1%) who had current seronegative partners, 8 disclosed and 3 did not disclose their status to their partner, 3 had new partners. By univariate test, significant factors were age, ART status, CD4 count, and family planning methods. By multivariate test, younger age (p = 0.006, OR 1.2, 1.1 to 1.3), being on ART (p = 0.008, OR 5.3, 1.6 to 18.3), CD4 >200 cells/mm³ (p = 0.004, OR 6.9, 1.9 to 25.0) remained significant risk factors, while tubal resection (p = 0.049, OR 0.1, 0.01 to 1.99) and use of condom alone (p = 0.025, OR 0.2, 0.1 to 0.8) remained significant protective factors. Husband’s HIV status, disclosure, number of children, and time since the last delivery were not significant factors.

Conclusions:  Being young, on ART, and having a high CD4 count were risk factors for recurrent pregnancy among our Thai women. It was interesting that condom use alone for family planning was found more protective than dual methods, which might result in inconsistent use of each method. To prevent any unplanned pregnancy, we propose that each woman along with her family should be assessed formally for the desire to have a baby and counseled properly for effective use of family planning methods at regular clinic visits.