What is included in patient education about HIV infection and pregnancy?

Updated: Apr 02, 2019
  • Author: Ashley T Peterson, MD; Chief Editor: Ronald M Ramus, MD  more...
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Approximately 30% of women in the United States are not tested for HIV during pregnancy. Reasons for declining should be explored and patients counseled appropriately. Testing strategies also include reoffering screening in the third trimester to women who declined first-trimester screening or who are in high-risk groups. The Centers for Disease Control and Prevention (CDC) recommends routine third-trimester screening in women with high-risk behaviors or who exhibit signs or symptoms of the disease. [4]

Clinicians who care for women with HIV need to provide family planning services and counseling regarding optimizing health status. This includes making a primary treatment goal of attaining an undetectable viral load prior to conception. Preconception care should include modifying current ART regimens to optimize viral suppression, encouraging compliance to medication regimens, cessation of smoking, and updating immunizations. Stressing the importance of taking their medication regularly to decrease the possibility of developing antiretroviral drug resistance may encourage women to comply with therapy. Cigarette smoking, concurrent use of drugs (cocaine, heroin), and unprotected intercourse have been associated with increased risk of perinatal transmission.

It is encouraging to note there has been a substantial reduction in substance use in the past 2 decades. [22] In a retrospective study over a 23-year period (1990-2012) that evaluated data from two prospective cohort studies (Women and Infants Transmission Study, Surveillance Monitoring for Antiretroviral Therapy Toxicities Study), investigators noted a dramatic decrease in substance use among 5451 HIV-infected pregnant women (1990: 82%; 2012: 23%). There was a significant decline in use of each substance between 1990 and 2006, when it reached a plateau, which the investigators suggested may have been caused by an epidemiologic transition of the HIV epidemic among US women. [22] Substance use was inversely associated with receiving antiretroviral therapy. Women with multiple pregnancies with substance use in their previous pregnancy were at higher risk of substance use in their next pregnancy. [22]

Unfortunately, 15% of women infected with HIV receive no or minimal prenatal care, and 20% do not initiate prenatal care until late in the third trimester. Even in the absence of antepartum treatment, intrapartum and early neonatal prophylaxis can reduce the mother-to-child transmission risk. Women with HIV should be extensively counseled regarding the ability to decrease the risk of perinatal transmission with ART. In women of reproductive age who are being treated with ART, the current regimen’s effectiveness, an individual’s hepatitis B (HBV) status, the potential for teratogenicity, and possible adverse outcomes for mother and fetus should all be considered.

All women who do not desire pregnancy should be counseled regarding contraceptive methods, including hormonal contraception and long-term reversible contraceptive methods. Emergency contraception options should be reviewed and made available to HIV-infected women who do not desire contraception.

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