Pregnancy in HIV‐infected women Counseling and care ‐ 12 years' experiences and results

Abstract

Background A specialized antenatal care unit was set up for counselingand care of HIV-infected pregnant women. The team consisted ofgynecologists, a midwife, a social worker and pediatricians.Methods. The women were referred from departments of infectiousdiseases, venereology or institutions for drug addicts, antenatal careunits and abortion clinics, or applied themselves. Women identified inthe pregnancy HIV screening program were informed primarily by the team.The women were counseled along with their partners and cared for duringabortion or the antenatal period, delivery and post partum.Contraceptive services were offered and psychosocial support was given.Results. Between April 1985 and March 1997, 95 HIV-infected women with122 pregnancies attended. Twenty-one per cent were or had been drugusers, 2% had been infected by transfused blood and 77% wereclassified as having been sexually infected, two thirds of whom wereAfricans. The mean age was 27.8 years. In 54 of 93 pregnancies (58%) inwhich the woman could make an informed decision, she elected abortion -in 37 cases for HIV related reasons. Significantly more women with anuninfected steady partner, compared to women without a steady partner,chose to continue the pregnancy, as did women in a relatively stablesocial situation. Of the partners, 68 were HIV-negative, 36 HIV-positiveand 18 not tested. No severe HIV-related complications occurred duringpregnancy. Seven of 40 (18%) children with a known infection statuswere infected. During the course of follow-up, nine mothers, two fathersand three children have died. Seventeen children were at risk of beingorphaned, and another five were placed in foster care.Conclusion. Although it is possible to reduce mother-to-infanttransmission by zidovudine therapy, the negative consequences of HIV andchildbearing are still substantial. Therefore HIV screening duringpregnancy and pre-pregnancy counseling are important issues for thehealth care system.