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Background To describe the findings of a German HIV-pregnancy cohort. To investigate factors associated with pregnancy complications and outcomes in HIV-infected women. Methods Retrospective analysis of HIV pregnancies from 2008 to 2010 in six German outpatient clinics specialized in HIV care. Results 230 mother-child pairs were included in the evaluation. In 25 cases, HIV infection was diagnosed during pregnancy (mean gestational age 17.5 weeks) with a mean CD4 cell count of 364 cells/µl and a median viral load (VL) of 6,660 copies/ml. 150 (65.2%) women were antiretroviral therapy (ART)-experienced prior to pregnancy; 112 (48.7%) received ART at conception; a further 97 (42.2%) started ART during pregnancy at an average gestational age of 25 weeks. Anemia was documented in 36.5% of the women with an average hemoglobin of 9.5 g/dl. Mean gestational age at delivery was 38±2.41 weeks; range 24-42 weeks. 17 births (7.4%) were preterm. Average CD4 cell count at time of delivery was 447 cells/µl; in 162 (70.4%) cases, VL was <50 copies/ml. Mode of delivery was as follows: 70 (30.4%) vaginal, 131 (57%) primary and 29 (12.6%) secondary Caesarian (C)-section. Vaginal delivery was associated with a higher gestational age at delivery (39.1 vs 37.5 weeks, p<0.001). Maternal CDC disease stage was found to be correlated with premature contractions (p=0.025), shortened cervix (p=0.044) and gestational age at delivery (p=0.042). Further, healthier women, according to CDC classification, were more likely to deliver vaginally (p<0.001). No vertical HIV transmission was documented. Mean birth weight was 2922±580 g. Conclusions In this cohort, lower CD4 counts were associated with preterm contractions, shortened cervix, and a lower gestational age at delivery. In addition, women with less advanced disease were more likely to deliver vaginally. [ABSTRACT FROM AUTHOR]