Healthy Mom, Healthy Baby
Pregnancy and Prenatal Issues
The 1999 Conference on Women and HIV was the first Conference I ever attended. I have to admit I was overwhelmed with information. Pregnancy and HIV is one of the most important subjects for me. I attended the sessions at the Conference (presenters included: Lisa O'Conner from San Francisco, Dr. Fogarty of Baltimore, Maryland, C. Torrilla, R. Boyton, J. Huerta and A. Fuentes) and I got a little additional information to share with you from "Being Alive" (12/1999 issue).
Quality of Care
The quality of care is very important when dealing with HIV+ women in general. Special needs arise for HIV+ pregnant women, because now you're looking at the treatment of an unborn. So, the physician must be knowledgeable of the various treatments available to pregnant, positive women. The patient and physician must have a very open, nonjudgmental and caring relationship. Quality of care is the most important factor in the outcome of both the infants' HIV status and the mothers' health.
Now, we all know how hard it is to adhere to these crazy regimens. We, as women, have many barriers to overcome including: social and physical issues, psychosocial and financial situations. When it comes to decisions about an unborn child, as mothers, we try our best to adhere to the medications.
Dr. Moxham of Durham, N.C. had statistical information on transplacental distribution of Emivirine (an experimental drug- NNRTI) in HIV infected pregnant women. In this study 14 women were given AZT and after a period of time Emivirine was added. This regimen was compared to AZT+3TC+Emivirine. The results were no different. Emivirine did cross the placenta, but as of right now, researchers agree that Emivirine needs more research.
The WIHS Study
The WIHS study shows that statistically there isn't a big difference between HIV positive and HIV negative women in terms of the effects of HIV on miscarriages, abortions, ectopic pregnancies (pregnancy outside of the uterus, i.e. Tubular pregnancy) and stillborns. This is probably due to ART (Anti-retroviral Therapy). Out of 255 women, 31.1% (79) had live births, 40.0% (102) had "elective" abortions, 20.9% (53) had miscarriages, 4.6% (11) had ectopic pregnancies and 1.5% (5) had stillborns.
We can't forget HAART (Highly Active Antiretroviral Therapy). Depending on the health of the mother, HAART during pregnancy can be a good choice because it is associated with low rates of perinatal transmission. A small study consisting of 67 women found that although, their rate of complications were low, 37% of the women had prenatal anemia (low on red blood cells before birth).
According to the American Medical Association there has been a 67 percent decline in mother-to-child transmission from 1993 to present.
Some studies show that transmission often occurs when the mother has a low CD4 count (T cells) and a high viral load. But we don't have an exact threshold that predicts transmission. In other words, we don't know the exact number of T-cells or the exact viral load level where transmission does not occur. So for now, it's probably better to just look at the CD4 count and the viral load to determine the mothers health and decide how best to treat her.
Prenatal care for HIV+ women should be done on a case by case basis. Taking into consideration the HIV issues of both the mother and the unborn child. This would include charting the viral load & CD4 counts, and balancing the risks and benefits of anti-HIV therapy during pregnancy. HIV positive women should expect their pregnancy and labor to proceed as if they were HIV negative.
Substance Abuse and Domestic Violence
Babies exposed to street drugs in utero often have abnormalities in their development, such as low birth weight or premature delivery. Prenatal care providers should discuss the enormous adverse health affects that street drugs (including alcohol and cigarette smoking) have during pregnancy. It should be a priority to provide referrals to resources dedicated to helping women with these addictions.
About 1/4 of women seeking prenatal care report they are abused by their partners. The rate of domestic abused HIV+ women may even be higher. These women suffer a great deal, as do their babies. Battered women are at risk of poor weight gain, infections, bleeding, anemia and of course, substance abuse during pregnancy. The babies born to these women are more likely to be underweight and premature. Help is available to women with substance use and domestic violence problems. So, let's make those referrals!
My overall comment on HIV and pregnancy is very simple. I know times can be rough for us, trying to stay healthy and keeping a happy home and now here comes a baby! But stay educated and informed on all medications available to you, including statistical information on each drug and try to have frequent discussions with your doctor. Being a woman is a joy, and the gift of life is always precious!
Back to the Women Alive Winter 2000 Contents Page.
This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.