Pregnancy and midwifery considerations in HIV

Karen Blyth: Victorian HIV Consultancy, The Alfred

Introduction and global overview

It is estimated around 1.5 million women with HIV give birth annually. Worldwide, AIDS-related illnesses are the leading cause of death among women of reproductive age (15 - 49 years). In 2013, 54% of women, particularly in low- and middle-income countries, did not receive an human immunodeficiency virus (HIV) test in the antenatal period, an important step in prevention of mother-to-child transmission. Without treatment one third of children with HIV die before their first birthday and half die by their second birthday.

In Australia, universal HIV testing is recommended for all pregnant women in the antenatal period, and supported by both the National HIV Testing Policy and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

The benefits of a woman knowing her HIV status during pregnancy include the opportunity for her to receive appropriate medical care for both herself and to prevent onward transmission of the virus to her unborn baby. There is the added benefit of prevention of transmission to any future partners or children.

In Australia, with appropriate monitoring, treatment and support the risk of transmission is now below 1%, while in resource poor settings, transmission though pregnancy, birth and breastfeeding may be as high as 40%.[2]

There are still an estimated 240 000 children worldwide who acquire HIV annually and the World Health Organization cites the main reasons for this as being limited access to sexual, reproductive and HIV health services for women; limited access to HIV treatments; failure to prioritise children and poor integration of health services.[3]

Between 2012 - 2016 there were 223 babies born to known HIV-positive women in Australia. Amongst HIV positive women between 1992 - 1996 this figure was 28%, which demonstrates the great advances that have been made in the management of pregnant women in the last few years.[4] However the need for continuing vigilance in the antenatal period remains very important and nurse and midwives play a pivotal role in this.