How does HIV/AIDS affect my pregnancy?

In a healthy mother, the placenta acts as a barrier and provides protection to the baby, so if the mother otherwise healthy, HIV will not transfer through the placenta to the baby. Malnutrition, a recent or advanced HIV infection, or in-uterine infections may affect the placenta’s ability to protect the baby.

Counseling is available to inform mothers about weight loss, STDs, malaria, tuberculosis, urinary tract infection, respiratory infection, unhealthy diet and the prevention of vitamin and iron deficiencies. If any of these complications should arise in a mother who has HIV, she may need to see her doctor more often during the pregnancy.

Amniocentesis should be prevented, as well as any other invasive procedure, in order to avoid exposing the baby to the mother’s blood or fluids, thus transferring HIV to the baby. If a baby is exposed to these fluids, the risk of transmission increases by 2% for every hour the membranes have been punctured.

Will my baby be born with HIV?

It is possible for a baby to contract HIV from his mother during pregnancy, delivery or while breastfeeding. Less than 1% of babies born to mothers with HIV will contract the virus if the mother is taking antiretroviral medication. This number increases to 25% if the mother does not take antiretroviral medication during her pregnancy.

A cesarean section may reduce the risk of the baby contracting HIV if it is performed before labor and/or the puncturing of membranes.

How can I have a healthy pregnancy as an HIV-positive mother?

All aspects of a woman’s health must be taken into consideration when dealing with HIV and pregnancy – psychological, medical, practical and social. An HIV specialist along with and obstetrician will manage the mother’s health and may suggest the use of a social services agency.

Counseling for the mother and her partner is also an option and should be utilized in a complete prenatal health plan.

What are treatment options for an HIV pregnancy?

An HIV-infected pregnant woman will most likely be prescribed Zidovudine (also known as AZT, ZDV and Retrovir®) which is used in combination with other antiretroviral medications and is used to prevent the transmittal of the virus from mother to baby. This medication can be taken throughout the pregnancy beginning in the second trimester.

If a mother has not received treatment during her pregnancy, it is imperative she be treated with a drug regimen during labor (drugs could include ZDV, 3TC, or Nevirapine). Studies show that these treatments can greatly reduce risk to the baby.

Will my baby receive treatment after delivery?

According to the National Institutes of Health, “it is recommended that all babies born to HIV positive mothers receive a 6-week course of oral ZDV to help prevent mother-to-child transmission of HIV. This oral ZDV regimen should begin within 6 to 12 hours after your baby is born.” This decreases the chance of passing the virus to the baby by 66%. Babies treated after delivery should develop normally.

Breastfeeding as an HIV-positive mother

Transmission of HIV by breastfeeding depends on the mother’s breast health, is the mother breastfeeds exclusively, the duration of breastfeeding and the mother’s nutritional and immune health. The risk for transmission of HIV to the baby is greater if the mother contracts HIV while she is breastfeeding.

Cancer During Pregnancy

The kinds of cancers that are common during pregnancy include:

• Thyroid cancer
• Melanoma
• Breast cancer (this is the most common cancer diagnosed during pregnancy and affects about 1 in 3,000 pregnancies. Since breasts change texture and size during pregnancy, cancer can go unnoticed and is difficult to identify.)
• Cervical cancer
• Hodgkin lymphoma
• Non-Hodgkin lymphoma
• Gestational trophoblastic tumor

Women who are pregnant with cancer are now being more easily treated than ever. The cancer itself seldom affects the baby, but can be an added complication for the mother and her health care team.

Cancer diagnosis during pregnancy

Although pregnancy and some cancers can share symptoms (breast changes, rectal bleeding, bloating, headaches), common tests during pregnancy can reveal cancer such as a Pap test or ultrasound.

If a mother is pregnant with cancer, some testing may be required to diagnose further and precautions are taken when performing these tests on a pregnant mother.

• CT or CAT scans: These computed tomography scans can diagnose cancer or easily determine if it has spread. A lead shield can be used to protect the fetus, especially if the doctor scans the head or chest. Scanning the pelvis or stomach could be detrimental, and should be discussed with the medical team.
• X-ray: The radiation emitted during an x-ray is too low to cause harm to the fetus, and a lead shield is often used to cover the mother’s stomach for extra protection.
• MRIs, biopsies, and ultrasounds are safe during a pregnancy since the don’t use ionizing radiation

Cancer treatment during pregnancy

Mothers must weigh the benefit of her treatment alongside the risk to the baby. Treatment is based on a few factors including the wishes of the mother and her family, stage of pregnancy, and the size, location, type and stage of the cancer.

Oncologists and obstetricians will work together with the mother and monitor her more closely, especially within her first trimester. The doctor might delay treatment during this time and may even push treatment until after delivery, depending upon how far along the mother is when she’s diagnosed.

A pregnant mother can participate in some cancer treatments including:

• Surgery: Surgery to remove the cancerous tumor is considered the safest form of cancer treatment for pregnant women and poses little risk to the baby
• Chemotherapy: There is a slight risk to the fetus if chemotherapy is given in the first trimester. Since the fetus’s organs are being developed in the first trimester, it is important to avoid chemotherapy during this time in order to prevent pregnancy loss or birth defects. Many types of chemotherapy can be given to pregnant women during the second and third trimesters.

Radiation therapy should be avoided since it can harm the baby in every trimester. The risk depends upon the location of the cancer being treated with radiation, and the level of radiation applied to that area.

Breastfeeding during cancer treatment

It is advised to avoid breastfeeding while receiving chemotherapy since the drugs can transfer to the baby through breast milk.

Pregnant with Diabetes

Babies born to mothers who have diabetes are at a greater risk of birth defects since high blood glucose levels pass through the placenta.

High blood glucose levels during the first trimester increase the chance of a miscarriage and birth defects. If you are thinking about getting pregnant, it is important to get blood glucose levels under control three to six months before trying. The baby’s organs are fully formed by the time you realize you’re pregnant (seven weeks after your last period).

Some risks a pregnant mother and her baby may face if the mother’s blood glucose levels are too high include:

• Miscarriage
• Premature delivery
• Macrosomia (delivering a large baby)
• Birth defects (usually not a risk for a mother with gestational diabetes)
• Prolonged jaundice
• Low blood glucose at birth
• Respiratory distress syndrome; difficulty breathing

Risks for the mother:

• Infections of the vaginal area and bladder
• Worsening of diabetic kidney and eye problems
• Difficult delivery or C-section
• Preeclampsia

Prenatal care for pregnant women with diabetes

If you’re a woman with diabetes, a well-rounded team should be a top priority when planning your pregnancy. This team should include the following:

• An expert in diabetes, and someone who can help manage your diabetes during pregnancy
• A pediatrician or neonatologist (specializes in newborns)
• A registered dietician who can customize meals as your nutrition needs change throughout your pregnancy and after delivery
• An obstetrician who deals with high-risk pregnancies and pregnant women with diabetes
• A doctor who is used to seeing patients with diabetes

Your health care team should consist of knowledgeable professionals whom you trust and who you’re comfortable going to with all your questions.

Diabetes treatment during pregnancy

Insulin is the best choice for diabetes treatment during pregnancy since it does not cross the placenta. It can be injected with an insulin pen, a syringe or with an insulin pen.

• Pregnancy with type 1 diabetes – The need for insulin will increase while pregnant, especially during the final trimester, because the placenta releases more hormones to help the baby grow. These hormones block the affect of the mother’s insulin.
• Pregnancy with type 2 diabetes – You may not be able to take diabetes pills while pregnant so your doctor will most likely switch your treatment to insulin. The American Diabetes Association does not recommend the use of oral diabetes medication during pregnancy since these medications can pass through the placenta.

Read more here.

Delivery and labor options for pregnant women with diabetes

There are techniques and classes a mother and her support team can learn in order to alleviate some pain before and during delivery.

Your health care team will determine the best time for you to deliver your baby based on your blood pressure, kidney function, blood glucose control and any diabetes-related complications you might have.

No matter how you decide to deliver your baby, your blood glucose levels will be monitored at every step and kept under control. Insulin needs will drop at the beginning of active labor and you probably will not need insulin for 2 to 3 days after delivery. Every few hours your blood glucose levels will be checked and your diabetes treatment will be customized based on your needs.

Home births are not recommended for women with diabetes since there is a high level of care needed before, during and after delivery.