HIV infection in pregnancy

At the initial visit, the healthcare provider should assess the patient's support system, establishing who knows of the patient's HIV status, problems encountered with disclosure, family and/or friends to whom she turns for ongoing support, and barriers to disclosure to sexual or needle-sharing partners. These issues should be readdressed at intervals throughout pregnancy as needed. The use of peer counsellors may be especially helpful.

Women who present for pregnancy care during the first trimester should be counselled on the risks (e.g., potential teratogenic effects, maternal adverse effects, increased risk of preterm delivery) and benefits (e.g., improved maternal health, reduced risk of perinatal transmission) of antiretroviral therapy (ART) during this period.

Discussion about postnatal contraceptive plans should be initiated in early to mid-pregnancy to allow comprehensive education and counselling about available options and adequate time for informed decision-making. Similarly, evidence-based, patient-centred counselling regarding infant feeding (including breastfeeding and replacement feeding) to inform shared decision-making, should be initiated during pre-conception or early antenatal care. History of and/or ongoing substance abuse, including abuse of tobacco and alcohol as well as illicit drugs, should be assessed at the initial visit and at intervals during antenatal care, if indicated. Type of substance(s), amount of use, route of administration, and prior drug or alcohol treatment should be documented. The patient should be counselled about specific risks associated with substance abuse in pregnancy, and drug or alcohol addiction treatment during pregnancy encouraged and facilitated for active problems.

Patient education and counselling about the importance of adherence to prescribed medications, particularly antiretroviral drugs, before they are initiated is recommended. Medication adherence should be assessed and reinforced at each visit. Pregnant women with HIV should be informed about the availability of, and offered participation in, clinical trials for which they are eligible.