In connection with pregnancy and the immunodeficiency disease AIDS,
the following situations must be distinguished:
- The affected woman only learned of her HIV infection during pregnancy.
- The infection has been known for some time and a pregnancy has occurred.
- The infection is known and there is a desire to have a child.
the first case, the positive test result often hits the pregnant
woman and the doctors treating her completely unprepared. If the
positive test result is confirmed after a control, the indication for
an abortion often arises immediately. Affected women are doubly
burdened - on the one hand by the fact of the HIV infection, on the
other hand by the necessity of a decision for or against the child.
is important not to act hastily, but to turn to competent contact
points who can help those affected in this difficult situation. The
counselling centres, HIV outpatient clinics and
hospital departments with experience in caring for HIV-infected
pregnant women are all possible options in this regard.
even competent counsellors cannot relieve those affected of this
serious decision. It must always be made by the woman alone or
together with her partner. However, appropriate information and
support can simplify the decision-making process.
recent years, the risk of infection in the unborn child has been
reduced from around 30 percent to less than two percent.
for this are:
- Cooperation between AIDS therapists and gynaecologists in prenatal care
- Adapted therapy against HI viruses (antiretroviral therapy, ART)
- Primary Caesarean section avoiding labor pains
- Preventive antiretroviral therapy for children
should HIV-positive pregnant women do?
optimal therapy and prevention, it is necessary for HIV-infected
pregnant women to be cared for in a centre that guarantees good
cooperation between the various medical disciplines. These centres
can provide care according to the latest state of knowledge. Close
cooperation between the centre and the gynaecologist is one of the
most important prerequisites for reducing the risk for the expectant
mother and, of course, for the child.
What considerations need to be taken into account?
- How can I cope psychologically if my child should also be infected?
- Do I have time and energy to take care of my child when it needs intensive care?
- Who will look after my child if I am in poor health or die?
an HIV-positive woman decides to have an abortion, this must be
respected. It is all too understandable that some of those affected
are simply overwhelmed in this situation and need all their energies
for themselves to cope with the situation.
the decision to have a child can also be a signal that the woman does
not give up and wants to develop further life perspectives, even
though she is infected with the immunodeficiency disease. This
decision should also be respected.
is it transmitted to the child?
(intrauterine) infection of the child occurring in the uterus is
possible during the entire pregnancy, but it preferably occurs in the
last third, especially during the birth process. Ascending infections
through the vagina are also a possible means of transmission.
following factors increase the probability of infection:
- Advanced disease stage of the mother
- Low number of T-helper cells or CD4 cells
- Increased virus concentration
- Certain virus variants and existing co-infections (e.g. hepatitis C)
- Premature birth, premature rupture of the bladder, premature labor pains
precautionary measures must be taken during pregnancy?
of all, the same precautionary guidelines apply as for non-infected
persons. Prevention in HIV-positive pregnant women under
antiretroviral therapy also includes regular laboratory checks -
depending on the medication administered. In addition, precise
gynaecological checks must be carried out to exclude infections of
the vagina and cervix which could be the cause of premature rupture
of the bladder or premature labour.
cell changes at the genitals, especially at the cervix, are more
frequent in HIV-positive women and can worsen, a regular colposcopy
(magnifying glass examination of the cervix) is recommended.
ultrasound examinations of the child should also be part of the
preventive programme. However, it is not advisable to have an
amniotic fluid puncture.
is important - parallel to the medical measures - to support the
pregnant woman in the psychosocial area. Medical education alone is
usually not enough to take away the fears and worries of those
affected. The offers of women's groups in the AIDS centres, for
example, are suitable for this.
is the mother-to-be treated?
to the USA recommendations on HIV therapy for pregnant women,
treatment during pregnancy should be adapted to the risk. In this
respect, the motto is: as much as necessary and as little as possible
is treated. The treatment depends on the blood findings and the
clinical state of health of the expectant mother.
drugs administered pose a certain problem, especially as the
harmfulness to the fetus of some preparations is not yet sufficiently
controlled. There are several treatment options. According to the USA
therapy recommendations, a triple combination therapy should be
carried out if possible.
it must always be considered whether this increases the risk of
damage to the child. The switch to a double combination is an
alternative in this case. If the immune situation allows the
antiretroviral therapy to be interrupted in the first three months,
this should be interrupted immediately after confirmation of
pregnancy. In order to avoid virus transmission to the child, the
active substance zidovudine should be administered from the 32nd SSW
onwards. If necessary, quadruple therapy may then be administered.
should the delivery be like?
present the caesarean section is propagated - if possible in the 37th
SSW. A tissue-sparing procedure should be preferred in order to
prevent the risk of transmission of the virus from the mother to the
child during the procedure as far as possible. Therefore,
contractions, premature rupture of the bladder, amniotic infection
syndrome and the passage of the birth canal should also be avoided.
After childbirth, the newborn receives antiretroviral therapy for
the case of a premature bladder jump, a caesarean section with
antiviral therapy of the mother should be performed immediately.
examinations of the child are necessary?
one would like to know as soon as possible after birth whether the
child is infected or not.
in this situation it is not possible to simply determine the
antibodies in the child's blood, because they still originate from
the mother. An IgG antibody test is only considered meaningful for
children aged 15 to 18 months. The IgA antibody can indicate an
infection earlier. In order to determine whether the child is
HIV-infected, a search is made for virus components in the blood. If
no virus particles are found, the child is considered HIV-negative.
is to be done after birth?
In general, the child should not be breastfed because the HI virus can also be transmitted via breast milk. First of all, the children need further antiviral therapy as prophylaxis, which should be carried out by experienced paediatricians. Regular controls of mother and child are necessary, with special attention to possible side effects of the medication.