HIV infection in Pregnancy

If a pregnant woman suspects that she may have been exposed to the HIV virus, it is important that her doctor is informed at once. 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.

Since the test is not usually immediately positive and it may take a few months for sero-conversion to occur, if the suspicion is strong, an offer of a course of anti-viral medication may be offered.

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. On learning that they are HIV positive, some mothers may opt for termination of pregnancy. Most such mothers opt to continue with the pregnancy. These mothers will need to explore the options available.

Options available to an HIV positive expectant mother

The mother will carry on with normal antenatal care until delivery. She will be advised to go on anti-viral 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.

Figures differ from different centers 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.

HIV infection and miscarriage or stillbirth

There is no evidence that HIV infection could lead to either miscarriage or stillbirth 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 labor.

HIV infection and mode of delivery

There is now evidence that cesarean 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.

Many of these mothers may be on medication already and for those who aren’t, medication is given at the time of delivery to reduce the risk even further.

Exceptions regarding mode of delivery may be made in cases where the mother has been on therapeutic doses of anti-retroviral drugs 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.

Effect of pregnancy on HIV infection

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.

HIV infection and 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.