CDC HIV/AIDS - Pregnancy and Childbirth

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pregnant womanPerinatal HIV Transmission

  • Accounts for nearly all pediatric AIDS cases. HIV transmission from mother to child during pregnancy, labor and delivery or by breast feeding accounted for approximately 91% of all AIDS cases reported among U.S. children between 1985 and 2004 (1).
  • Can be prevented. Data indicate that when appropriate antiretroviral medications are given during pregnancy, labor and delivery and after birth, the risk of transmission can be reduced to less than 2% (2) compared with approximately 25% when no interventions are given (3).
Key Prevention Strategies
  • Early diagnosis
    • Ideally, all women should be tested for HIV infection as a routine part of their medical care prior to pregnancy.
    • Women who become pregnant without knowing their infection status represent important missed opportunities for prevention.
    • HIV screening should be a routine component of preconception care for all women.
  • Prevent unplanned pregnancies and plan desired pregnancies
    • Nearly half of all pregnancies in the United States each year are unplanned. Many cases of mother-child transmission could be averted if HIV-infected women who do not desire pregnancy avoided unplanned pregnancy.
    • For women with HIV infection who are planning pregnancy, preconception care must focus on maternal infection status, viral load, immune status and therapeutic regimen as well as education regarding perinatal transmission risks and prevention strategies, expectations for the child’s future and where desired, effective contraception until the optimal maternal health status for pregnancy is achieved.
    • Specific counseling should be provided as needed regarding assisted reproductive technologies available to prevent HIV exposure to uninfected partners and to prevent superinfection with resistant or more virulent virus.
  • Routine, early prenatal HIV testing
    • Universal, routine HIV screening of all pregnant women should occur as early as possible during every pregnancy.
    • The test should be included in the routine panel of prenatal tests.
    • Women should be notified that the test will be performed unless they specifically decline (This strategy is called the “opt-out” approach).
    • Approximately 12% of HIV-infected women giving birth between 1999 and 2001 in 24 Enhanced Perinatal Surveillance sites received no prenatal care (4). Many HIV-infected women cite discrimination and discomfort as reasons for avoiding prenatal care (5). Providing accessible, welcoming prenatal care services for all women is an important strategy for prevention of perinatal HIV infection and for providing opportunities to protect women’s health.
  • Second HIV test in the third trimester
    • Many cases of perinatal HIV transmission have occurred in infants whose mothers had a negative HIV test earlier in pregnancy.
    • Universal, routine retesting in the third trimester, preferably before 36 weeks of gestation, has comparable cost-effectiveness to other routine health interventions even in low-prevalence settings and may be considered for all women in the United States.
    • A second HIV test in the third trimester is specifically recommended for women at increased risk of HIV infection and for women in certain states and facilities (8).
  • Antiretroviral medications
    • Antiretroviral medications including zidovudine (ZDV) should be used as appropriate for the woman’s health and to reduce HIV-1 transmission risk (6).
    • Appropriate use of antiretroviral therapy and prophylaxis can reduce the risk of perinatal transmission to less than 2% (6).
  • Scheduled cesarean delivery
    • Scheduled cesarean delivery before onset of labor or rupture of membranes can reduce risk of HIV transmission when maternal serum viral copy numbers are not sufficiently reduced by antiretroviral therapy (6).
  • Testing in Labor and Delivery
    • Universal, routine rapid HIV testing should be conducted using an opt-out approach for women who arrive at labor and delivery without a documented prenatal HIV test (7).
  • Newborn Testing
    • Rapid HIV testing of newborns whose mothers were not previously screened for HIV offers a last chance to provide antiretroviral prophylaxis to HIV-exposed infants (7, 8).
  • Avoidance of breastfeeding
    • HIV transmission through breastmilk accounts for approximately one third of perinatal HIV transmission in populations in which this practice is common (9-11).
    • All HIV-infected mothers in the United States should be counseled to avoid breastfeeding and should have reliable access to a safe, affordable, appropriate breastmilk substitute (6).
  • Linkage to HIV care for mother and infant
    • HIV-infected women and exposed infants should be supported by linkage with appropriate medical and other services necessary for their own health after delivery.

References

  1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004. Atlanta: US Department of Health and Human Services 2004.
  2. Cooper ER, Charurat M, Mofenson LM, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr. 2002;29(5):484-94.
  3. Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O'Sullivan MJ, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med. 1994;331(18):1173-80.
  4. Centers for Disease Control and Prevention. Enhanced Perinatal HIV/AIDS Surveillance, United States, 1999-2001, Special Surveillance Report No. 4. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.
  5. Lindau ST, Jerome J, Miller K, Monk E, Garcia P, Cohen M. Mothers on the margins: implications for eradicating perinatal HIV. Soc Sci Med. 2006 Jan;62(1):59-69.
  6. Department of Health and Human Services, U.S. Public Health Service Task Force. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. October 12, 2006.
  7. Gerberding JL, Jaffe HW, Centers for Disease Control and Prevention. "Dear Colleague" Letter, April 22, 2003.
  8. Centers for Disease Control and Prevention. Revised Recommendations for HIV Testing of Adults, Adolescents, And Pregnant Women in Health Care Settings. MMWR Recommendations and Reports. 2006;55(RR-14);1-17.
  9. de Martino M, Tovo PA, Tozzi AE, Pezzotti P, Galli L, Livadiotti S, et al. HIV-1 transmission through breast-milk: appraisal of risk according to duration of feeding. Aids. 1992 Sep;6(9):991-7.
  10. Datta P, Embree JE, Kreiss JK, Ndinya-Achola JO, Braddick M, Temmerman M, et al. Mother-to-child transmission of human immunodeficiency virus type 1: report from the Nairobi Study. J Infect Dis. 1994 Nov;170(5):1134-40.
  11. Bertolli J, St Louis ME, Simonds RJ, Nieburg P, Kamenga M, Brown C, et al. Estimating the timing of mother-to-child transmission of human immunodeficiency virus in a breast-feeding population in Kinshasa, Zaire. J Infect Dis. 1996 Oct;174(4):722-6.
source - CDC

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