HIV/AIDS and Pregnancy: Steps to Protect Mother and Child
The pregnancy news is often followed by love, laughter, and excitement for the little munchkin’s arrival!
However, pregnancy is also an endless journey of everything extra! That is, extra love, extra care, followed by a mandatory extra medical know-how.
Now imagine you getting diagnosed with HIV during pregnancy, marking a double dilemma in your pregnancy journey.
The risk of this transmission is about 15-45% from mother to the child during pregnancy, labor, and breastfeeding, which can be reduced to 2% with proper and timely treatment.
This blog will provide all the essential guidelines to follow for HIV-positive expectant mothers. It also includes steps on how to manage HIV during pregnancy.
Understanding HIV/AIDS
HIV stands for the human immunodeficiency virus and can attack and weaken the body's immune system and T-cells, which play an important role in immune defense.
HIV, when left untreated, progresses to AIDS, also known as the acquired immunodeficiency syndrome, which further reduces immunity and makes the body susceptible to many infections, cancer, etc.
According to a study, about 1.3 million pregnant women are diagnosed with the risk of delivery transmission with HIV. In India, HIV transmission during pregnancy ranges from 0.7% to 1.2%.
There are five steps in understanding and curing HIV/AIDS during pregnancy. It begins with the diagnosis, antiretroviral therapy, and prevention of mother-to-child transmission, followed by postnatal care.
Impact of HIV/AIDS on Pregnancy
HIV can impact the pregnancy in case of a high viral load. That is, when there are almost 1000 copies/ml or an unknown viral load in the mother’s blood, near the time of the delivery.
I. How Is HIV transmitted To The Baby During Pregnancy?
This is also known as vertical transmission or mother-to-child transmission (MTCT), the risk of which increases with the increase of the viral load or uncontrolled HIV due to improper ART.
This could happen during the following stages:
- Pregnancy: Through the placenta, which is responsible for fetal nutrition and development. There is an uncontrolled HIV in the case of high viral load in the mothers.
- Labor or Childbirth: When the baby comes into direct contact with the mother’s blood and vaginal fluids. It is always recommended to have a C-section in case of a high viral load.
- Breastfeeding: In case of cracked or bleeding nipples.
II. Potential Risk Of Infections To Pregnant Women With HIV
During pregnancy, the immune system replaces itself to support the conception and development of the fetus with a sperm, which is usually a foreign agent for the woman's body.
Also, it encourages inflammation of the body to support the growing fetus. It also enables the mother to be at high risk of other infections due to the compromised nature of the immune system during pregnancy.
Potential Infections: Tuberculosis, pneumonia, parasitic, thrush, sepsis, hepatitis B and C, etc.
This increased vulnerability to infections in the mothers might further prove detrimental to their lives and well-being.
III. Effects On Fetal Development
HIV carries a possible risk of transmission to the child when exposed to the mother's blood, vaginal fluid and breastfeeding during pregnancy.
Pregnancy complications with HIV can delay fetal development, causing issues such as low birth weight, preterm birth, neurodevelopmental delay, chronic diseases, long-term health issues, etc.
IV. HIV Remedy
One of the most important measures for HIV is a proper and timely consultation with antiretroviral therapy (ART) to reduce and fix potential infections in newborns.
In addition, it is always recommended to have a cesarean delivery in the case of a high viral load and inappropriate antiretroviral therapy (ART) management.
V. What Is Antiretroviral Therapy (ART)?
It is a standard treatment of HIV to prevent its transition and progression to AIDS. It uses different HIV medications and does not eliminate the infection but controls its transmission by decreasing the viral load in the body.
An expectant mother who is positive and is undergoing a proper ART would showcase a low viral load. This further helps in the prevention of risks of HIV transmission from mother to child.
Preventing Mother-To-Child Transmission (PMTCT)
The transmission of HIV to the baby is a serious concern but can be eliminated or cured with effective prevention strategies.
I. Importance Of Early HIV Testing
Pregnant women are mostly checked for HIV, either before pregnancy or during early pregnancy, and if not, then mandatorily during the third trimester. This is because an early diagnosis, followed by an appropriate treatment, encourages safe delivery and a healthy mother and baby.
II. Antiretroviral Therapy (ART) Protocols
This ensures a dedicated schedule for its remedy, like:
- Early initiation, immediately following the diagnosis.
- Consistency to maintain a low viral load.
- Regular consultation and check-up with the healthcare provider to understand the side effects.
- Regular monitoring of the viral load in the mother’s blood.
III. Safe Delivery Practices
This helps in reducing the transmission risk from the mother to the baby, which is decided by regularly monitoring and tracking the viral load in the expectant mothers. Also, a planned delivery method is accompanied by oral or intravenous labor and by avoiding invasive procedures at all costs in case of a high viral load to prevent the transmission.
Post-delivery, the newborns diagnosed or at risk of HIV, in case of high viral load in mothers during delivery, receive prophylactic ART for around 4 to 6 weeks to further restrict its transmission.
IV. Guidelines For Breastfeeding
● Low Viral Load: Mothers undergoing an exclusive ART and with good health must breastfeed their baby regularly for at least six months, according to WHO guidelines. This is known to reduce the risk of HIV transmission to the baby. Also, mixed feedings should be avoided, which is a mix of breast milk plus formula feed, or other liquids or foods, etc., to prevent its transmission.
● High Viral Load: In this case, formula feeding is usually considered the best option to prevent its transmission.
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Scenario |
Prevention |
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Mother HIV-positive Father HIV-negative
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● Begin ART for the mother immediately to achieve an undetectable viral load. ● C-section, if viral load is detectable at delivery. ● Formula feeding is recommended if the viral load is detectable and exclusive breastfeeding otherwise. ● Prophylactic ART for newborns for 4-6 weeks.
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Mother HIV-negative Father HIV-positive |
● Pre-exposure prophylaxis (PrEP) for the mother before conception and during pregnancy. ● Use a condom or protection during sexual intercourse. ● Regular HIV testing for the mother during pregnancy.
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Both mother and father are positive.
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● Continue ART for both parents to maintain an undetectable viral load. ● C-section, if viral load is detectable during delivery. ● Formula feeding or exclusive breastfeeding if ART is adhered to and viral load is undetectable. ● Postpartum ART for both mother and newborn.
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Caution: PrEP is very essential for the negative HIV partners in case the other partner is HIV-positive.
Managing HIV/AIDS During Pregnancy
This includes diligent following of the below-mentioned pointers:
I. Regular prenatal care: It helps in monitoring and management of viral loads in the body to track the potential risk of viral load in the body with regular blood tests, and infections. This is necessary for the prevention of transmission of the child from the mother.
II. Adherence to ART: This treatment should be balanced with managing its potential side effects and placing a suitable balance with significant pregnancy nutrition.
In addition, special care must be taken to avoid the prevalence of drug resistance, which can reduce the effectiveness of treatment.
III. Nutritional considerations: Pregnancy demands a rich, well-balanced diet with the necessary supplements to increase fetal development and development.
In addition, medium exercise during this time prevents overall physical, mental, and emotional health, thus helping to deal with anxiety and stress due to HIV diagnosis.
Support Systems And Resources
Due to the increasing risk of pregnancy complications with HIV, the expected mothers must get the necessary support, guidance, and resources to help them cope with fear of their child's transmission and welfare.
Healthcare provider plays an active role in diagnosis, guidance, treatment, and educating the expected mothers. They also provide essential mental health assistance required by patients.
During this time, the role of family and friends is equally important to provide relief and strength. In addition, various other counseling services or psychiatrists can help provide necessary mental assistance.
In addition, there are also various government and non-government programs to assist HIV positive pregnant women at the national and international level, including UNICEF.
These programs provide education, financial, and emergency assistance, thus encouraging a successful HIV/AIDS treatment.
Conclusion
The nine-month period during pregnancy marks various physical, mental, and emotional transformations in the expectant mothers.
Adding up this challenge with an HIV diagnosis could further enhance the transmission and infection risk to both the baby and the mother, respectively.
However, regular prenatal check-ups, routine blood tests, and proper and timely ART can help in the prevention of its transmission further.
In addition, it is equally important to normalize it with the expected mothers to get general care and support. It is one of the most important steps to reduce the risk of HIV transmission from mother to child.
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