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Mother to Child Transmission (MTCT)Antiretroviral drugs are one of a number of interventions that can be used to help prevent HIV being passed from a mother to her unborn child. Mother-to-child transmission (MTCT), also known as vertical transmission, may occur
A woman can minimize the risk of HIV being passed to her child by certain interventions. These include:
In many well resourced countries women take advantage of all of the available interventions and this has resulted in a very low transmission rate of HIV from mother to child. With no interventions the rate of transmission can be in the region of 25-45%. With all interventions the rate can be as low as 2%. In countries where fewer facilities are available, there has been some success in reducing the transmission rate by use of a small dose of drugs during labour. Generally the antiretroviral drugs will not be recommended for the mother before weeks 12-14 of pregnancy, unless there is an urgent medical reason. The main reason for waiting is that the antiretroviral drugs could have an adverse effect on the baby in the early stages of it's development. The first drug that was used to prevent MTCT of HIV was AZT in 1994. AZT remains the only drug thoroughly studied for use in pregnancy. AZT use during pregnancy has had a significant impact on MTCT in countries where its use has been widely adopted. There are also other alternative drugs available such as nevirapine, 3TC and the combination AZT + 3TC. Your health care provider should have details about suitable drugs and the availability of them in your country. One widely used option for HIV-positive women is to take antiretroviral drugs during labour. Antiretroviral drugs taken during labour can minimize the risk of transmitting HIV from mother to baby and in some countries with fewer facilities, this is the only way available to prevent mother to child transmission of HIV. In many countries, which lack medical facilities, small doses of nevirapine are provided during labour free of charge by the manufacturer. There is no firm recommendation of the 'safest' route of delivery of the baby when you are HIV-positive. The two ways of delivering your baby, vaginal delivery and caesarean (c-section) both have their benefits and risks. Caesarean section is an operation used to deliver a baby through its mother's abdominal wall. With HIV-positive mothers, caesarean sections are increasingly planned and performed before the onset of labour to protect the baby from direct contact with the mother's blood and genital tract secretions. This procedure is called elective caesarean section. To further minimize the baby's contact with the mother's blood, a 'bloodless caesarean section' is being advocated. This method of delivery involves controlling the mother's blood vessels (by heat, cold, electricity or staples) so the bleeding is blocked. For women who have an access to good prenatal care and HAART, it is not known whether caesarean section provides any additional benefit to the use of effective HAART. Although the benefits of caesarean may sound appealing, some doctors will not recommend it because of the risks to the mother's health In resource-limited countries caesarean section may pose a risk of infection or may simply be unavailable. In countries where antiretrovirals are available, it is standard prevention practice to give anti-HIV drugs to infants born to HIV-positive women for a certain period of time. HIV is found in breast milk. Women with HIV are, therefore, advised not to breastfeed when they have access to safe milk substitutes. Without any other interventions, the overall rate of mother-to-child -transmission of HIV is about 15-25% among HIV-positive women who do not breastfeed1 and 25-45% among HIV-positive women who breastfeed . Some studies have found that breast-feeding can 'undo' the benefits that may be gained through the use of antiretroviral therapy during pregnancy and labour. In countries, where safe water is not available, the risk of other life-threatening conditions from formula feeding may be higher and more immediate that the risk of HIV from breast-feeding. The high cost of formula may also limit it's use in certain countries. Also, in some societies formula feeding is stigmatised and may identify the woman as HIV-positive. Feeding a baby with breast milk and other liquids such as formula, glucose water, gripe water or traditional medicines is called mixed feeding. In some studies, it has been found that mixed feeding is riskier than exclusively formula or breastfeeding. Mixed feeding may damage the lining of the baby's stomach and intestines making it easier for HIV in breast milk to infect the baby. Women may choose mixed feeding because of the stigma attached to formula feeding in some countries, or because they cannot exclusively breastfeed due to illness, employment etc. HIV-positive mothers are advised not to breastfeed when alternatives are available, but more research is needed to compare the risks of exclusive breastfeeding and mixed feeding. Becoming pregnant if you are HIV-positiveIf you are an HIV-positive woman and you are thinking of having a child, it is good to think about the issues around pregnancy. Your health care provider should be able to help you decide the best option for your health and your baby's health. You may feel that you baby's health is the most important, but your health is important as well. You should receive the same standard of care that is available to any woman who is thinking of getting pregnant or who is already pregnant. Positive women who are pregnant are as healthy as those positive women who are not pregnant. An HIV positive woman who is pregnant, can consider taking anti-HIV drugs (after the first few months of pregnancy) to help her own health, as well as taking them to prevent mother to child transmission of HIV. HIV does not change how the pregnancy proceeds and does not affect the development of the baby. In certain countries, HIV positive women have the opportunity to consider taking drugs during labour, choose the method of delivery, abstain from breastfeeding and give their babies certain anti-HIV drugs. These intervention methods are explained in more detail above. Sometimes an HIV positive woman who is already on treatment will find out that she is pregnant. Advice should be obtained urgently from your doctor about what it is best for you to do. It may be sensible for you to change the drugs that you are taking, as some drugs are more suitable during pregnancy than others. It is not a good idea to come off or change your therapy before seeing your doctor. If you stop your treatment suddenly, your viral load may rebound, and there may be an increased risk of HIV transmission to the baby. If you are thinking of changing or stopping your treatment, you must see your doctor. Learning you are positive when you are pregnantSometimes a woman will find out that she is positive when she is pregnant. Obviously, a major concern is the well being of the child, but as explained above there are certain things that can be done to prevent HIV being passed from mother to child. It is important that you talk to your health care provider about the best options available for you and your baby. TestingYour baby can have an HIV antibody test but it will not necessarily show straight away whether the baby is infected. All babies born to mothers with HIV are born with HIV antibodies. Babies who are not infected lose their antibodies by the time they are around 18 months old. So it is only after your baby is 18 months old that the HIV antibody test will give an accurate result. In some cases the use of other diagnostic tests, such as the polymerase chain reaction (PCR), has been recommended as a more rapid way of finding out the status of your baby. However, the PCR test is not widely available in many countries. AVERT.org has more information about children, HIV & AIDS and about mother to child transmission of HIV. References:
Last updated October 22, 2004 |