Unfortunately, in recent years, HIV infectionhas become very widespread. But, despite the fact that HIV infection is still only partially treatable, the life expectancy of a sick person is quite long - up to 15 - 20 years. And therefore it is not surprising that many HIV-infected women have a desire to have a child, especially if they still do not have children. Someone condemns such a desire of sick women, someone supports it. However, the fact remains a fact, regardless of how others feel about it - having a child is the choice of a woman who wants to leave a mark. And this choice is her right, because only a woman can take responsibility for the life and health of her child. However, this does not stop many HIV-infected women - HIV and pregnancy go hand in hand not so rarely, as it may seem at first glance. And in some cases, a woman decides to give birth to an HIV-infected man. However, the expectant mother should never forget that pregnancy in the presence of HIV infection is radically different from all the others. Giving birth to a healthy child is quite possible, but the expectant mother will have to make a lot of efforts to achieve this. But what will a mother not do for the sake of her child's health? This is what we will talk about below.
Conception of a child in a HIV positive couple
Caring for a child's health should begin withfrom the very beginning – from conception. Correct conception allows to significantly reduce the risk of infection of the baby. The fact that a child can be infected with HIV during pregnancy, childbirth or breastfeeding is known to everyone. But few people know that it is impossible for a child to be infected by a father who has HIV infection, since the virus does not penetrate sperm. Both the egg and sperm are absolutely sterile – they do not contain anything except the nutrients necessary for the development of the embryo, as well as the genetic information of the parents. But this is only one side of the coin. As you know, sperm are in a biological fluid – in the seminal fluid, in which the concentration of the immunodeficiency virus is the highest. And this means that an infected man with a very high degree of probability can transmit the virus to a healthy woman. And even if this does not frighten a woman, she must remember that she, in turn, can infect the future baby. And even if both partners are infected, unprotected sex for the purpose of pregnancy is also extremely dangerous. Once in the human body, the immunodeficiency virus changes. And during unprotected intercourse, partners infect each other again, each with their own type of virus. In addition, in such a situation, there is a risk of transmitting the virus from mother to child, so it is still not worth taking such a risk. It is precisely in order to avoid these complications that modern medicine offers several methods of alternative conception for couples where one or both partners are HIV-infected. Such methods include:
- A couple in which a woman is infected
In case HIV is infected in a couplewoman, the most optimal and safe option is artificial insemination (not to be confused with artificial fertilization). During ovulation - approximately on the 13th - 14th day of the menstrual cycle, during the release of a mature egg from the ovary, the doctor inserts previously collected seminal fluid into the woman's vagina.
- A couple in which a man is infected
If the man in the couple is infected,Doctors offer several options. The least frequently used is sexual intercourse that is not protected by a condom. To do this, the couple, with the help of doctors, must carefully plan the time of ovulation - when the egg has left the ovary and is ready for fertilization. The day must be set precisely in order to maximize the chances of fertilization, since each repeated unprotected sexual intercourse increases the risk of infection of the woman several times. Before this method of fertilization, sexual partners must be carefully examined for the presence of certain diseases, and, if necessary, treat them. In addition, doctors will conduct special therapy that will significantly reduce the risk of infection of the woman - this is a very important measure of preparation for conception. The second method of conception in this situation is sperm purification and direct insertion into the vagina on a certain day of the menstrual cycle, when the egg is ready for fertilization. This method of fertilization is currently one of the safest for a woman and her future child, which is why doctors recommend this method of conception to couples in which the husband is HIV-infected.
The beginning of pregnancy
So, everything worked out for the couple and the woman is pregnant.Then begins a period no less important for the health of the future baby - the pregnancy itself. The expectant mother should contact the nearest AIDS center as soon as possible. The specialists of this center will prescribe all the necessary tests for the expectant mother, register the woman, and issue a number of pharmacological drugs that will help reduce the risk of HIV transmission from mother to child. In addition to observation at the AIDS center, the expectant mother should register for pregnancy as early as possible. Of course, during the first visit you will have to tell your gynecologist about your disease, but remember that your doctor is your main ally in the fight for the health of the child. Therefore, try to build a good relationship with your doctor. Do not take with hostility certain questions or advice from the doctor - understand one thing: no one will judge you, and the doctor asks all the questions only to help you and your child. As a rule, the doctor sends the expectant mother for a number of standard examinations during pregnancy. These include: a general blood and urine test, determination of blood sugar levels, ultrasound. However, in addition to this examination, an HIV-infected expectant mother, as a rule, needs to take blood tests that will determine the viral load and immune status of the pregnant woman. These studies are vital - on their basis, the doctor will be able to assess not only the behavior of the virus and the state of the immune status, but also understand the general condition of the expectant mother's body. Based on this data, the doctor will be able to determine further tactics of antiretroviral therapy. In addition, if the pregnancy was not planned and the woman did not undergo a full examination of the body before conception, the doctor will prescribe her tests that will show whether the expectant mother has sexually transmitted diseases, blood tests for hepatitis. In addition, the doctor will take a smear to determine the vaginal microflora. A woman should never ignore regular visits to the doctor - gynecologist and strict compliance with all his requirements. Otherwise, there is a certain risk of premature birth. And premature birth significantly increases the likelihood of infection of the child with HIV.
Medical procedures during pregnancy
Most of the doctors are gynecologists andVirologists rightly believe that an HIV-infected pregnant woman should be protected as much as possible from various types of medical procedures. Of course, we are talking about those procedures that are somehow connected with a violation of the integrity of the skin and mucous membranes, and even more so with the invasion of the mucous membrane of the uterus. All these measures significantly increase the risk of transmitting HIV infection from mother to fetus. As a rule, all such procedures are usually prescribed to pregnant women for the purpose of diagnosing certain developmental defects and genetic diseases in the fetus. And if in the case of a normal pregnancy such studies are almost completely safe for both the mother and the future baby, an HIV-infected woman takes a very big risk during such procedures. Therefore, if a woman has any concerns, she should consult a geneticist even before pregnancy. However, if an HIV-infected pregnant woman is prescribed such procedures, she has every right to ask the doctor to explain why such a need exists, whether it is possible to replace these procedures with other methods of examination, for example, ultrasound, which does not require penetration into the uterus. In the same case, if for one reason or another it is impossible to refuse such procedures, the pregnant woman must ensure that the doctor prescribes a viral load test before the intervention, which determines the level of the virus in the blood. In addition, it is necessary to conduct an additional course of antiretroviral therapy, which will help to significantly reduce the likelihood of infection of the child.
What should I look for?
There are several key points to considerwhich an HIV-infected woman should pay special attention to. The main points include opportunistic infections. For a pregnant woman with HIV infection, any disease poses a serious threat. However, the most undesirable are the so-called opportunistic infections, which are typical for immunodeficiency and are nothing more than an indicator of the progression of the disease. Below are described ways to prevent such infections:
- Pets
Very many pets are oftensources of infection. Even if the animal looks healthy, it can be a carrier of certain pathogenic bacteria and viruses. Therefore, if the future HIV-infected mother has pets, she should entrust their care to members of her family and regularly examine the animal with a veterinarian.
- Environment and nutrition of the future mother
The expectant mother must be very careful withwater. Firstly, it is absolutely unacceptable to drink raw water – only boiled or bottled water. Secondly, during pregnancy it is necessary to avoid swimming in natural bodies of water, because there may be quite a large number of microbes there. It is equally important to exclude contact of a pregnant woman with soil, avoid contact with farm animals, for example, with cows, sheep and goats. It is equally important to refuse raw dairy products and eggs. All products must be purchased only in specially designated places, avoiding spontaneous markets.
- Regular visit to doctors
Very important for an HIV-infected expectant motherbe observed by all necessary specialists in a timely and regular manner. Which specialists exactly is decided individually in each specific case, depending on the existing concomitant diseases. But specialists from the AIDS center and a gynecologist are strictly mandatory in this list. As a rule, during a normal course of pregnancy in the first half, a woman should visit the above-mentioned specialists twice a month, and after that as often as the doctors deem necessary. If the pregnancy is proceeding normally, the expectant mother is hospitalized in a maternity hospital approximately two weeks before the expected date of delivery. In the same case, if there are any deviations during pregnancy, hospitalization can be carried out at any time when the doctor deems it necessary. Refusing hospitalization is in no case acceptable - after all, in the presence of HIV infection, the risk of developing various complications increases several times.
Features of the course of HIV as a result of the effect of pregnancy
It has long been scientifically proven that duringpregnancy there is always a significant decrease in the immune system - this is necessary so that the woman's body does not reject the fetus. And it is quite natural that an HIV-infected woman worries about how pregnancy will affect her immune system, which is already weakened by the virus. Many believe that this natural change in the immune system can accelerate the development of HIV infection and worsen the course of the disease. However, numerous and long-term observations of the course of the disease in HIV-infected pregnant women indicate that no progression of the disease is observed during the period of bearing a child. Moreover - inexplicably, but true - more than half of the women experienced a significant improvement in the state of the immune system after pregnancy. However, of course, only on condition that the expectant mother receives all the necessary treatment. Also, one cannot ignore such a sensitive issue as the methods and probability of infection of the child. In the event that a pregnant woman does not take any preventive measures, the probability that the child will be infected is approximately 40 - 50%. There are several ways in which HIV can be transmitted from mother to child – during pregnancy, childbirth, and even during breastfeeding.
- Infection during pregnancy
In some cases, the virus comes from the mother's bloodstreamthrough the placenta can penetrate to the fetus. Normally, the placenta should protect the baby from various infectious agents contained in the mother's blood, including HIV. But if for some reason the placenta is damaged or involved in an inflammatory process, its protective function is significantly reduced, and HIV can penetrate from the mother's body to the fetus's body.
- Infection during childbirth
There are two ways a child can become infected.during childbirth. Firstly, the child may get the virus during the birth canal if there are small abrasions or ulcers on its skin or mucous membranes. Or the child may swallow the vaginal secretions and blood of the infected mother during childbirth. And through the mucous membrane of the stomach and intestines, HIV can get into the child's blood.
- Infection during breastfeeding
If you are breastfeeding, your baby maybecome infected both directly through breast milk and through blood if the mother develops cracks in her nipples. The risk of infection of a child during breastfeeding is approximately 40%. Therefore, doctors often suggest transferring the child to artificial feeding immediately after birth. This is much safer than breastfeeding in this case.
Risk factors for infecting a baby
Doctors divide the factors that significantly influence the level of risk of a child becoming infected with HIV into three main groups:
- Maternal factors
One of the most important factors isviral load of the mother's body. The higher the woman's viral activity, the higher the risk of the child becoming infected with the human immunodeficiency virus. Another important factor is the woman's immune status. The lower the content of immune cells in the blood of a pregnant woman, the more likely it is that the child will also become infected. In addition, the lifestyle of an HIV-infected pregnant woman plays a significant role. For example, all bad habits, such as smoking, drinking alcohol, significantly worsen the state of the immune system, which means that the risk of transmitting the human immunodeficiency virus to the child also increases significantly. In addition, the presence of various genital infections in a woman has a very unfavorable effect. In order to reduce the risk of transmitting the immunodeficiency virus from mother to child, doctors use special antiretroviral therapy.
- Obstetric and gynecological factors
There are also certain gynecologicalfactors. One of the first such factors is premature rupture of membranes. If the anhydrous period is more than three hours, the risk of the child becoming infected with the human immunodeficiency virus increases by approximately 40%. And then each subsequent hour of the anhydrous period increases the risk of transmitting the virus by ten percent.
- Fetal factors
The physiological characteristics of the child also matterthe risk of transmitting the immunodeficiency virus depends. For example, the weight of a newborn baby plays a very important role - the lower the baby's body weight, the greater the chance that the virus will be able to penetrate the child's body. And this is not surprising - if the child has a small weight (less than 2500 g), his immune system is not well developed enough, and the protective reaction of the mucous membranes and skin is also still very weak. All these factors together lead to an increased risk of infection of the child with the immunodeficiency virus. The same is true for premature birth - the earlier the birth, the less developed the child's immune system. In addition, doctors note the following feature - if an HIV-infected woman gives birth to two babies. The risk of infection with the virus is much higher for the first baby. This is explained by the fact that the child passing through the birth canal first is in contact with the mother's biological fluids - blood and vaginal discharge - for much longer. In most cases, if a pregnant woman is infected with HIV, doctors decide to perform a cesarean section. This method reduces the risk of the child becoming infected with HIV by about 45%. It goes without saying that in this case we can only talk about a planned cesarean section, for which doctors begin to prepare the expectant mother in advance and systematically. If everything is done correctly, the risk of transmitting the virus is no more than 3%, which is a very good indicator. Thus, our readers can see for themselves that the birth of a healthy child in a woman infected with the immunodeficiency virus is quite possible. However, for this, expectant mother and father must closely cooperate with doctors - gynecologists and specialists from AIDS centers. Doctors will help to choose a suitable antiretroviral therapy regimen for the mother, as well as the necessary preventive course for the newborn baby. In order for all measures to prevent the transmission of the immunodeficiency virus from mother to child to be truly effective, parents must very carefully follow all the recommendations of doctors. This is especially true when it comes to taking pharmacological drugs - a clear and precise treatment regimen is very, very important to achieve the desired positive result. If the expectant mother not only misses taking certain medications, but even just violates the time intervals, the effectiveness of the treatment will decrease significantly. However, pregnancy and HIV infection are not mutually exclusive. Therefore, remember that if you really want something, it will definitely come true. And your baby will delight you for many years to come. After all, it is unlikely that you can find anything more precious than a child's smile and laughter! We recommend reading:
