HIV, Pregnancy, and Motherhood

Health and Wellness 26 September 2017 | 0 Comments

Human immunodeficiency virus can be transmitted in three other methods besides sexual contact with an infected person; such as, direct contact with infected blood and blood products, breastmilk from an infected mother, and mother-to-infant transmission at birth.

A surprising number of mothers throughout the world were unaware that they have been infected either by their husband or another partner, and unwittingly infected their newborn in the process. Transmission of the virus can be prevented through HIV screening at one of the clinics or hospitals in Singapore or through an anonymous HIV test done at home through an HIV test kit.

Risk Factors for Mothers

It is possible for a mother to be HIV-infected, but still have a baby who is free from the infection. First, it must be determined if the woman is at risk of contracting the virus at in Singapore through practices such as unprotected sex, having multiple partners, having a partner or husband who is HIV-positive, and the sharing of equipment such as needles.

If you are pregnant, your doctor will recommend that you undergo HIV testing during your first antenatal appointment, and another during the third trimester or 36 weeks of gestation. This test is different from the routine prenatal checks that all expectant mothers go through.

Some doctors in Singapore also recommend that a high-risk mother should get an HIV screening right after the delivery of the baby. The newborn will need HIV testing as well, but the methods will differ from those recommended for the mother.

The husband or partner should also get tested, because he is the most likely culprit for infecting the pregnant woman.

As a preventative measure for couples, some doctors advice individuals planning to have a baby to get tested for sexually-transmitted diseases (STDs) and HIV. Having an STD (especially infections that cause skin lesions such as sores) can also place either you or your partner at risk for contracting HIV.

Testing the Mother

HIV testing is generally accurate, but you will need at least two tests within a 3-month window period to determine if you really are HIV-positive. The earliest test can be performed 3 weeks after the initial infection, so that the virus can be detected in the samples. Testing a pregnant mother for HIV isn’t different from the HIV screening recommended for adolescents and adults.

All the existing HIV testing methods can be classified into two general types; testing for HIV antibodies and testing for the virus itself. The antibodies are the part of your immune system that fight infections, such as HIV. There is a specific antibody that targets certain infections, and the laboratory technicians will specifically look for the presence of HIV antibodies. The antigen on the other hand, is part of the virus that the antibodies will respond to. Some tests include both methods that look for the virus and the antibodies in the blood sample.

If the first test is positive, a different test is needed to confirm the result. If the first test is positive, but the second is negative, the result is called false positive.

HIV-positive pregnant women are recommended to undergo treatment to prevent the infection of the baby. A check-up and several laboratory tests will be required every 3 months to keep the baby healthy. You will need antiretroviral therapy (ART) and you might have to undergo a C-section if the viral load is at a high level. The baby will also be given antiretroviral treatment until he/she can be tested. Breastfeeding and pre-chewing food for the baby is also not allowed until the child is old enough.

Testing the Infant

If the HIV-positive mother is given the appropriate treatment, the chances of transmitting the virus to the infant is reduced to 2% according to studies, as opposed to a 25% chance when there is no treatment. That is why besides the medication, therapy, and tests, the mother should avoid the following risks to reduce transmission: STD infection, smoking and substance abuse, malnutrition, vitamin A deficiency, and high viral load.

There is no way to know if the infant is infected until he/she gets an HIV screening. However, testing infants for the disease can be tricky especially during the first four months of life. Infants younger than 18 months require special HIV testing such as the extraction, amplification, and detection of the HIV nucleic acids. Why is HIV difficult to detect in infants? That’s because the HIV antibody of the infant isn’t distinguishable from the HIV antibody of the mother. The HIV screening aims to distinguish the HIV RNA from the infant’s RNA.

Once the baby is older, HIV tests in Singapore clinics and hospitals that will detect the presence of HIV antigens and/or antibodies can be performed.

Postpartum Care

For babies exposed to HIV, the following treatments are required: postpartum antiretroviral (ARV) drugs, infant ARV prophylaxis, and neonatal Zidovudine prophylaxis for the next four weeks. Even if the baby’s mother has a resistance to ARV, the same treatment will still be recommended for the infant.

For premature babies, either prophylaxis and treatment or prophylaxis alone is recommended, but ARV drugs cannot be prescribed because there is a risk of overdosing.

The doctors must take special care during the delivery by avoiding episiotomies or incisions to enlarge the vaginal opening and the rupturing of the amniotic sac, because the baby will be exposed to more infected fluids and blood. The baby might be given Zidovudine within 8 to 12 hours after birth to decrease the likelihood of infection, and the treatment will continue for the next 6 weeks.

The mother will also receive continuous treatment for HIV and will be given advice how to protect her child from exposure.

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