Pregnancy and HIV

HIV is a complex disease, and can affect a pregnant woman’s health. Learn more about what can be done to optomize the chances of a healthy birth, including medication options.

It is a woman’s personal choice to have a baby or not. The same goes for an HIV positive woman. Despite contrary belief, a woman living with HIV can deliver a healthy child free of the virus. While there is no complete way to prevent it, new improvements have been made to reduce the risk of mother-to-child HIV transmissions (sometimes called vertical transmissions). There is no proof that pregnancy will speed up HIV progression rate. Likewise, there is no proof that by having HIV, it will change the way the pregnancy will carry on. There is, however, a great risk to both the mother and the child if the mother has an HIV-related opportunist infection. Opportunistic infections are diseases and sicknesses that the body, because of HIV, may not be able to fight off.

Still, there is not proof that the development of the child will be affected, despite the mother’s HIV status. There are, though, risks of the mother transmitting the virus to the child. According to Project Inform, an advocacy organization catering to individuals living with HIV/AIDS, the chances of an HIV positive woman delivering an uninfected child increases if she follows certain guidelines: Excellent prenatal care, anti-HIV therapy, effective delivery plan, and right breastfeeding choices.

Prenatal Care.

This is quite possibly one of the most important guidelines women must follow to increase the chance of giving birth to an uninfected child. First-class prenatal care, from a knowledgeable doctor, should include education, tests, nutrition, exercise, and counseling. It is important that she visits a doctor experienced in handling situations with HIV positive women as soon as she finds out she is pregnant. Some doctors are not as knowledgeable in this field, and may not know the latest treatments available. Knowing this, finding the right doctor is no doubt imperative. The first three months are critical in the future of the mother and child as it is a time when the child’s major organs are developing.

Valuable prenatal care should include:

* An initial evaluation.

* Standard prenatal exams like blood pressure, weight monitoring, and urine tests.

* Blood tests.

* Viral load – a test that measures the RNA of the virus. The RNA is a part of the virus that makes more of itself.

* A CD4+ cell count test – to check HIV levels.

* Other tests for STDs (sexual transmitted diseases).

* Pelvic exams and pap spears.

* Changes in nutrition including eating healthier, taking vitamins with folic acid, iron, calcium, and drinking plenty of fluids.

* Effective exercise that will make pregnancy and delivery easier.

It is recommended that prenatal visits to a doctor should be monthly until she reaches eight months of pregnancy. After that, the visits should increase to twice a month, and sometimes weekly.

Some prenatal tests should be avoided for HIV positive women unless absolutely necessary. Such tests to be avoided include amniocentesis, chronic villus sampling, cordocentisis, internal fetal monitoring other than ultrasound, and percutaneous umbilical cord sampling. Amniocentesis, for instance, involves a needle passing through the mother’s abdomen into the uterus. If this, and other tests are necessary, the mother will be given anti-HIV treatments before the procedure to lessen the risk of HIV transmission.

Anti-HIV Therapy

Developing an anti-HIV drug treatment that is both beneficial to the mother and the child is difficult. There is no guarantee as to which drugs best suit the mother and child because there has not been enough research. What researchers do know is ATZ (zidovudine, Retrovir) is the only proven and approved drug for preventing mother-to-child HIV transmission. In fact, the drug has been proven to decrease vertical HIV transmission from 25% to 8.3% roughly.

Taking AZT for the woman will usually involve a three-part treatment. First, AZT should be taken after the first trimester and throughout the pregnancy. Second, the mother will need the drug injected in her vein during labor. And third, AZT, in its liquid form will be given to the newborn child during his/her first six weeks. This three-part treatment is just one of several research studies on AZT. One study suggest that one dosage of AZT given to the mother at labor or to the child during the first 48 hours after birth can reduce the rate of transmission as effectively as the three-part treatment. Another study revealed that AZT taken by the mother starting at 36 weeks of pregnancy, and then orally every three hours during labor may cut mother-to-child HIV transmission rates in half.

Although AZT is the only proven drug effective in reducing the risks of mother-to-child HIV transmission, it is still recommended that it be taken with other drugs. Keep in mind that certain drugs may affect the development of the child. These rare complications may include prematurity, bleeding in the brain, and a rare brain disorder that may cause death. Drug resistance, a condition when HIV modifies anti-HIV drugs causing them to be no longer effective, may also occur. Thus women need to talk to their doctors about developing an anti-HIV drug therapy that suits their situation.

Of course there is the issue of morning sickness making it difficult to keep the medication down. Some women wait until the second trimester to start her anti-HIV drug therapy. When a pregnant woman does start her drug therapy, she must keep track of her medications at all times. Missing doses or not taking it at the right time, for example, may result in an increase in transmission risk. Women must also remember to fit their medication around their lives, not the other way around.

The Delivery

A woman has a choice of delivering her child either by C-section or vaginal delivery. A child’s contact with maternal blood is inescapable in both instances. To help reduce risk of transmission, doctors have been experimenting with different procedures. One such procedure is called elective C-section. In this process, a C-section is performed before labor begins and the mother’s membranes rupture. By doing this, the child may be protected from the mother’s genital track secretions and blood. There are, however, higher rates of complication to both the woman and the child.

Another procedure is called “bloodless C-section” or “bloodless delivery.” The mother’s blood vessels are cauterized (burned and scarred) so they don’t bleed. The amniotic sack is then opened, and the baby is taken out of the womb. This procedure, costing around $8,000, is definitely not for everyone.

Breastfeeding

Research indicates that there is a 29% HIV transmission rate from HIV-positive women who breastfeed their child. Women, of course, are told to avoid breastfeeding at all costs. Alternatives include store bought formula and human milk banks that screen for HIV.

It is important to note that vertical HIV transmission research has been extremely limited. More research still needs to be done to confirm these studies and conclude the long-term effects on the mother and baby. As for the mother, some people may give their own opinions and advice on the pregnancy but ultimately, it comes down to her decision. There is support out there for expectant HIV-positive mothers. The key is finding them.

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