Continued AIDS and Motherhood (my research paper)

Save the Children
By Rochelle Casavant
Nursing 210
Audrey Quinn
November 24, 2007

























In the United States, since the beginning of the epidemic, AIDS has been diagnosed for

an estimated 8,460 children who were infected perinatally. Of those, an estimated 4,800 (57%)

have died. Perinatal HIV transmission is the most common route of HIV infection in children

and is now the source of almost all AIDS cases in children in the United States (CDC 2007 p.1).

Having HIV does not need to end people’s lives, mothers can still have happy, healthy families.

Preventing mother-to-child transmission (MTCT) of HIV can be done with antiretroviral

therapy (ART) medications, cesarean section (CS), and bottle feeding instead of breast feeding. These three strategies will greatly reduce the risk of transmission of HIV to the infants. The CDC states, ART administered to the mother during pregnancy, labor and delivery, and then to the newborn, as well as elective CS, can reduce the rate of perinatal HIV transmission to 2% or less (2007 p.1). This paper first will explain the need for antiretroviral medication. Also, it will show the need for cesarean section. Last it explains the need to bottle feed to help reduce the risk of HIV transmission.

Giving antiretroviral therapy medications to mothers before and during pregnancy and to the infant after birth reduces the risks of transmitting HIV. Pregnant mothers, who are HIV-positive, should begin to take ART medication as soon as they find out they are pregnant. Also, they need to have it given intravenously while giving birth, and the infant needs to take ART medication for 6 weeks to help reduce the risk of transmission. ZDV is started orally at 14 to 34 weeks gestation, given intravenously to the mother during labor and administered to the infant for six weeks. In the United States, taking prophylactic medication during pregnancy can dramatically reduce, but not eliminate, the risk of vertical transmission. The reported rates of MTCT of HIV are less than 2% for women who begin treatment early in pregnancy, 12-13% among women who do not initiate treatment until labor, delivery, or after birth (Kirshenbaum 2004 p.106). One common ART medication is Zidovudine (ZDV). Kirshenbaum states, four out of five women pregnant at diagnosis of HIV reported taking ZDV as a vertical transmission risk reduction strategy. Women voiced trust in the medication and seemed to contemplate a wide array of vertical transmission risk reduction strategies (2004 p.110). After 2000, in the United States, when ART became widely used in pregnant women, 1,839 infant infections were averted (Walensky 2006 p.16). One of the major achievements in HIV research was the demonstration that administration of ZDV to the pregnant women and her infant can reduce the risk of perinatal transmission by nearly 70%. In the United States, without ART approximately 25% of pregnant women infected with HIV will transmit the virus to their child (CDC 2007 p.1&2).

Another way to reduce mother to child transmission of HIV is to have an elective cesarean section. Children who are vaginally delivered have a high risk of becoming infected with HIV due to the vaginal secretions and bleeding during delivery. Vaginal delivery is associated with increased risk of MTCT, this increased risk is ascribed to increased exposure to infected genital secretions and micro trauma during birth (Mohlala 2005 p.488-490). The greatest benefit in preventing transmission is associated with cesarean delivery performed before the rupture of membranes or to the onset of labor in conjunction with ART prophylaxis (CDC 2007 p.4). The most potent predictors of perinatal HIV transmission are prolonged rupture of the amniotic membranes, and mode of delivery. Several studies done in South Africa have demonstrated that delivery by CS reduces MTCT significantly. Recruited into the study were 26 HIV-positive pregnant mothers. For 23 of the 26 fetuses, fetal cord blood samples obtained at birth were negative for HIV RNA. Their findings demonstrated that women with healthy pregnancies who underwent elective CS before labor, at 38-40 weeks of gestation, almost all gave birth to HIV free children (2005 p.488).

The last thing to do to prevent mother to child transmission of HIV is to bottle feed and to not breast feed. There is a high risk of transmission of HIV through breast milk. Though it is healthy for mothers to give their child the first milk, which is colostrum, with HIV-positive mothers the risks outweigh the benefits. Since HIV can pass through breast milk, it is safest for HIV-positive mothers not to breast feed (Boston Women’s Health Book Collective 2005 p.304). More than one-third of all MTCT of HIV in breast-feeding population is estimated to occur via breast milk (Rousseau 2004 p.1880). During 1992-1998, a randomized clinical trial was conducted of breast feeding versus formula feeding in infants of HIV-infected mothers in Nairobi, Kenya, and found the frequency of breast milk transmission to be 16%. MTCT of HIV through breast feeding led to 44% of infants being infected (Richardson 2003 p.736). In 1998, United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) revised their guidelines on feeding infants of HIV-positive mothers in developing countries. Previously breast feeding was recommended for all mothers including HIV-positive mothers. Now with more understanding of disease HIV the revised guidelines recommend “avoidance of breast feeding” to prevent MTCT of HIV even in the developing countries (Whitney 2001 p.244).

In the absence of interventions, the rate of mother to child transmission of HIV is 15-25% in Europe and the United States and 25-40% in Africa and Asia. WHO estimated that, in 2002, HIV-infected children accounted for 10% of the infections in developing countries. Perinatal transmission accounts for more than 90% of HIV infections in infants and children, and it is also responsible for almost all new HIV infections in preadolescent children (Mohlala 2005 p.488). MTCT of HIV is a complex process that can occur while the fetus is in utero, during
delivery of the infant, or through breast feeding (Richardson 2003 p.736). The first thing to do to reduce the risk of mother to child transmission of the disease pregnant mothers should take antiretroviral medications. Second, pregnant mothers need to have a cesarean section delivery. Last, mothers should bottle feed their babies and not breast feed.







































Reference Page

Center for Disease Control and Prevention. (October 2007). Mother-to-child (perinatal)HIV transmission and prevention. CDC HIV/AIDS Fact sheet. Retrieved November 17, 2007 from http//:www.cdc.gov.

Kirshenbaum, S., Hirky, E., Correale, J., Goldstein, R., Johnson, M., Rotheramborus, J., et al. (2004). Throwing the dice: Pregnancy decision-making among HIV-positive women in four U.S. cities. Perspectives on Sexual and Reproductive Health, 36 (4), 106-113. Retrieved on November 12, 2007 from CINAHL database.

Mohlala, B., Tucker, T., Besser, M., Williamson, C., Yeats, J., Smit, L., et al. (August 2005). Investigation of HIV in amniotic fluid from HIV-infected pregnant women at full term. The Journal of Infectious Diseases, 192, 488-491. Retrieved on October 28, 2007 from CINAHL database.

Richardson, B., John-Stewart, G., Hughes, J., Nduati, R., Mbori-Ngacha, D., Overbaugh, J., et al. (March 2003). Breast-milk infectivity in human immunodeficiency virus type1-infected mothers. The Journal of Infectious Diseases, 187, 736-740. Retrieved on November 20, 2007 from CINAHL database.

Rousseau, C., Nduati, R., Richardson, B., John-Stewart, G., Mbori-Ngacha, D., Kreiss, J., et al. (November 2004). Association of levels of HIV-1-infected breast milk cells and risk of mother-to-child transmission. The Journal of Infectious Diseases, 190, 1880-1888. Retrieved on November 2, 2007 from CINAHL database.

The Boston Women’s Health Book Collective. (2005). Our bodies, ourselves. New York: Simon & Schuster.

Walensky, R., Paltiel, A., Losina, E., Mercincavage, L., Schackman, B., Sax, P., et al. (July 2006). The survival benefits of AIDS treatment in the United States. The Journal of Infectious Diseases, 194, 11-19. Retrieved on November 2, 2007 from CINAHL database.

Whitney, E., Cataldo, C., DeBruyne, L., Rolfes, S..(2001). Nutrition for health and health care. California: Peter Marshall.