According to the March of Dimes, more than 90 percent of the approximately 9,000 U.S. children diagnosed with AIDS since 1985 contracted the virus from their mother during pregnancy or birth. Preventative measures can greatly reduce a pregnant woman’s risk of transmitting the HIV virus to an unborn child. For this reason, it is very important for pregnant women to know the options available to maximize the chances for keeping their baby HIV-free.
Treatment Protocol During Pregnancy
The American Pregnancy Association says HIV-infected pregnant women should undergo a treatment protocol of HIV-fighting drugs. Doctors recommend taking Zidovudine, also known as ZDV, AZT or by the brand name Retrovir, beginning in the second trimester to prevent mother-to-child transmission. Side effects include nausea, vomiting and low red or white blood cell counts. These medications should continue until the baby is born, regardless of the mother’s viral load or CD4 count.
The health risk of these medications is still unclear, according to the March of Dimes, although they do not appear to pose a significant risk to the fetus. For safety reasons, doctors do not recommend taking some of the newer medications, as of 2010, like efavirenz and delavirdine, known as Sustiva and Rescriptor, respectively, during pregnancy.
Delivery Options
The risk of mother-to-child transmission of HIV may be higher for a vaginal delivery than for a scheduled cesarean, according to the National Institutes of Health (NIH). Doctors recommend a cesarean delivery when a mother’s viral load is unknown or greater than 1,000 at 36 weeks of pregnancy, if there has been no prenatal care prior to week 36 or if the mother has failed to take anti-HIV medications throughout the pregnancy. Ideally, cesareans should occur around 38 weeks of pregnancy, prior to the membranes rupturing, commonly referred to as the breaking of the water.
Vaginal delivery is considered safe when a mother has received prenatal care and taken anti-HIV medications throughout her pregnancy, and has a viral load less than 1,000 at 36 weeks. In some cases, doctors recommend vaginal delivery when labor is progressing rapidly and the membranes have ruptured.
Treatment During Delivery
HIV-positive women who have not received drug treatment prior to labor should receive ZDV together with 3TC or Nevirapine intravenously. The NIH says these medications should start three hours before a scheduled cesarean delivery and continue until the baby is born. During a vaginal delivery, a woman should receive intravenous AZT throughout labor and delivery.
Labor & Delivery Precautions
The risk of HIV transmission increases should fetal exposure to HIV-infected blood or fluids occur during delivery. The March of Dimes states that doctors take care to avoid procedures that could potentially expose the fetus to HIV. Examples of such procedures include intentionally rupturing the amniotic sac to induce labor, a procedure known as amniotomies, along with episiotomies, amniocentesis and fetal-scalp blood sampling.
Post-Delivery Infant Treatment
All babies born to HIV-positive mothers should receive oral AZT to prevent mother-to-child transmission. The treatment should begin within six to 12 hours after birth and continue for six weeks. Babies born to HIV-positive mothers should take medication to prevent pneumocystis carinii pneumonia, or PCP, a common AIDS-related opportunistic infection. The recommended treatment is a combination of sulfamethoxazole and trimethoprim, which according to the NIH should begin around the age of six weeks once the AZT treatment is complete. PCP-preventative treatment should continue until HIV testing on the baby is complete.
Post-Birth Infant HIV Testing
Because a baby retains its mother’s antibodies, babies often test positive for HIV through the first 18 months of life. Viral load testing occurs at birth, at one to two months of age, and again at three to six months of age. According to the NIH, a child is HIV-negative if he tests negative on two of these preliminary tests and again during an HIV antibody test at 18 months. A child will receive an HIV diagnosis should he test positive on two of these preliminary viral load tests, and again test positive during an antibody test at the age of 18 months.
