HIV in Pregnancy
If an expectant mother suspects that she has been exposed to the HIV virus, what should she do?
It is important that her doctor is informed at once, and she will be given thorough counseling. This will normally lead to an offer for a test to check whether the infection has been passed on to her.
What is the importance of screening for the HIV infection in pregnancy?
Apart from the obvious longer-term benefit of the mother knowing whether she has the infection or not, there is the immediate issue of the newborn baby. Some expectant mothers, on learning that they are HIV positive, opt for termination of pregnancy. Those who opt to continue will need to explore the options available.
What are the options available to an HIV positive expectant mother who wishes to carry on with the pregnancy?
The mother will carry on with normal antenatal care until delivery. She will be advised to go on medication which has been shown to significantly reduce the chances of the baby acquiring the infection from the mother. For obvious reasons, the short- and long-term effects of these drugs to the baby are not fully understood, even though so far children exposed to them in the womb have shown no ill effects. There is a lot of research going on in this area and new management strategies are being developed all the time.
What percentage of babies acquire the infection from their mothers?
Figures differ from different centres but roughly a third of all babies will be infected when they are born. Antiviral medication to the HIV infected expectant mother is estimated to cut this risk by over two-thirds.
Does HIV infection lead to miscarriage or stillbirth?
There is no evidence that HIV infection could lead to either of these directly. If the infection was acquired a few years back, it may have advanced to full-blown AIDS which is, of course, characterized by recurrent infections, some of which may lead to miscarriage or preterm labour.
Can caesarean section reduce the rate of transmission of the virus from the mother to the baby?
There is now evidence that caesarean delivery confers a significant advantage in preventing HIV infection for the baby. This is the method of delivery that is, therefore, advocated for most mothers with the infection.
Medication is given at the time of delivery to reduce the risk even further.
Exceptions may be made in cases where the mother has been on therapeutic doses of anti-retrovirals and blood tests show that the viral load is very low or undetectable. In such a case, there is probably no advantage in performing a caesarean section and a vaginal delivery can definitely be preferable.
What is the effect of pregnancy on the disease itself?
A number of early studies did suggest that pregnancy may accelerate the progression of the disease to full-blown AIDS. Better-controlled subsequent studies have failed to support this claim.
What is the advice regarding breast-feeding?
In developed countries, the advice is to avoid breast-feeding. This is because there is a small but real risk of transmitting the virus to the baby via breast-milk. In the presence of good substitutes, the risk is not considered worth taking.