Preventing Mother-to-Child Transmission of HIV in Pregnancy

By Dr. Okechukwu Amako, MBBS (Ibadan)
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One of the tests recommended during antenatal care for a pregnant woman is the HIV screening test. This is important because some women may not know they are HIV positive and go on to become pregnant without adequate planning and medical care, thereby predisposing the unborn baby to the virus and other risks such as being delivered prematurely.

To significantly reduce the risk of transmission from an HIV-positive pregnant mother to her unborn baby, it is important she knows her status and immediately starts receiving treatment and counselling throughout her pregnancy, during delivery, and after delivery. Mother-to-child transmission of HIV can happen during pregnancy, delivery, and breastfeeding.

To prevent Mother-to-child transmission of HIV:

1. All pregnant women who have been diagnosed with HIV should start receiving antiretroviral therapy regimen known as HAART (highly active antiretroviral therapy) to suppress the viral load to undetectable levels in the blood thereby minimising the risk of transmission to the unborn baby. So, pregnant mothers who are HIV positive are advised to ask their obstetrician all the necessary questions concerning their condition and how to receive the appropriate treatment.

2. Towards the expected date of delivery, the woman is placed on an antiretroviral drug called zidovudine which has been shown to reduce the transmission of the virus to the baby during delivery. Also, with adequate antiretroviral therapy, HIV positive pregnant mothers can choose to go for elective caesarean section before they go into labour as this has been shown to significantly reduce the risk of transmission of the virus to the baby.

3. Once the baby is delivered, he or she is given a dose of an antiretroviral drug called nevirapine within 72 hours and then zidovudine for the next 6 weeks.

In addition, HIV-positive mothers are advised to either do strict exclusive breastfeeding of their babies for the first 6 months after which it should be stopped at once, not gradually. The breast milk should be expressed and heated at 62°C for 12 minutes to inactivate the virus present, further reducing the likelihood of transmission.

On the other hand, an HIV positive mother can avoid breast milk totally and give the baby the appropriate formula feeds if:
-if she has a breast abscess
-her nipples are bleeding
-test shows her viral load to be high
-and she can afford and sustain the supply of the right baby formula feeds.

These mothers should never mix breastfeeding and formula feeds as this increases the risk of the baby contracting the virus from the mother through breast milk.

The HIV status of the baby can be confirmed using a test known as HIV DNA PCR or the mother can wait till her baby is at least 18 months to do the common HIV antibody test.

Children born to HIV-positive mothers should receive all the recommended immunizations; they should also be placed on good nutrition as recommended by the doctor (paediatrician) and the human nutritionist.

Mothers of children who have been confirmed HIV positive should ensure these children receive both the appropriate antiretroviral therapy regimen and preventive treatment against opportunistic infections such as pneumocystis jiroveci pneumonia. They are also advised to go for post-natal care where they will be counselled on family planning and the need to continue their own antiretroviral therapy regimen based on their doctor's recommendation.

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Published Tuesday, April 11th 2017

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