How to prevent vertical transmission from mother to child

An infected pregnant woman can transmit the virus to her baby during pregnancy, childbirth and breastfeeding.

Preventing transmission from mother to child

Transmission of HIV from mother to child - Vertical transmission - is responsible for more than 90% of infections among children under 15 years. The effects of this situation are dramatic. AIDS has started to turn back decades of steady progress in the field of child survival and their quality of life. Today there are effective and feasible procedures to reduce transmission from mother to child that can save the lives of 300 000 children each year.

Children at risk

Only in 2000.the estimated number of 600000 newborns was infected with HIV and over 90% of them got HIV transmission from their mothers. About 90% of these infections occurred in sub-Saharian Africa.

HIV can be transmitted to the unborn child during pregnancy or the infant during childbirth or breastfeeding. The risk of infection varies between 15% and 30% among newborns who do not breastfeed. Breastfeeding increases the risk of further infection by 10 - 15%.

Vertical transmission in the developed world is almost completely eliminated as a way of HIV transmission through effective voluntary counseling and testing, the availability of combined antiretroviral therapy and / or prolonged use of modes of transmission prevention of mother to child, safe birth procedures (including the option of cesarean section if necessary) and wide availability of breast milk substitutes.

Prevention of infection

A special strategy is needed to prevent and eliminate vertical transmission. It implies that women are protected from infection and to avoid unwanted pregnancies in HIV positive women and women at risk of infection. Also, such a strategy includes the prevention of virus transmission from mother to child during pregnancy and childbirth and during breastfeeding. Voluntary counseling and testing are an essential part of this strategy.

It is clear that short-term antiretroviral prophylactic therapy is an effective and viable solution to prevent HIV transmission from mother to child. When combined with counseling and support to mothers about infant feeding and the use of safer methods of such a diet, you can halve the risk of neonatal infection.

These regimes are largely based on the use of Nevirapine and Zidovudine. Nevirapine is used in a single dose given to the mother before delivery and one that is given to the child within 72 hours after birth. Typical short-term use of Zidovudine begins in 36th week of pregnancy and is given daily to the mother until and during childbirth.

The main challenges remain

There is a need to better informe people about the fact that HIV can be transmitted from an infected mother to her child and that there are measures that the risk of vertical transmission can be significantly reduced.

A large number of HIV positive women are living in poor conditions, often with a lack of access to clean water, sanitation and other basic needs, which limits their ability to use safe substitutes for breast milk. Researchs on how to make breastfeeding safer for the child are of high importance. Some studies show that children that were breast-fed with mothers milk are less likely to get HIV than children who received milk replacer, however, such research must be further confirmed.

The availability of voluntary counseling and testing should be improved and the reluctance of many women to get tested for HIV should be replaced by a conscious and informed choice. Hesitance is often a response to stigma and discrimination in connection with the concern that women will be deprived of social and medical support and care if they are found to be HIV positive.

The data on vertical transmission in Serbia

During the period 1987-2002 in the City Institute of Public Health in Belgrade was registered 30 cases of vertical transmission of HIV. Three of them were not in Belgrade. In 14 cases, the Belgrade Institute has data that indicate the HIV-positive status of mothers, 7 of them had heterosexual way of transmission, 4 with transmissons as results of drug use and 3 with unknown way of transmission.

If a woman knows that she is infected with HIV, there are medications that can be taken to significantly reduce the chances to her child be infected as well