Taking care of yourself during pregnancy ensures the best outcome for you and your baby..

GOLD chatted to gynaecologist Dr Robyn Spring and the team at the Desmond Tutu TB Centre about what you need to know to keep you and your baby healthy during and after your pregnancy.

From the Expert
What advice do you have for teenage girls who find they are pregnant and want to keep their babies?

• First things first, getting through a pregnancy and keeping a baby, are all very responsible things to do, so you need to become responsible - about your health and the health of your baby.
  
• That means going to the clinic early (as soon as you find out you are pregnant) at which time the sisters will check you out, estimate your due date, start you on the appropriate vitamins you need, and get you tested for things like your blood group and iron levels.
  
• Very importantly, they will also offer counselling and voluntary HIV testing. In Botswana and Zambia, when you are pregnant and visit the clinic you will be tested for HIV unless you opt out of the test. Having the test is a really responsible thing to do. It gives you the chance to know your status, and it gives the sisters and doctors the chance to be able to care for you and protect your child by getting you onto ARV’s which can reduce the chances of you transmitting HIV to your baby.
  
• After your initial visit, it is important that you follow your clinic sister’s advice regarding checkups. If they detect any problems, they will refer you on for more help.
  
• You also will need to start preparing for your baby’s arrival by getting nappies, clothes, products etc. Chat to your mom or a female relative or friend who has a baby to find out what you need to get.

Pregnancy Health Basics
Follow these steps to make sure you have the best chance of keeping you and your baby in tip top shape.

• Attend the clinic regularly for check-ups.
  
• Choose a healthy lifestyle. Avoid alcohol and smoking.
  
• Eat plenty of fresh fruit and vegetables.
  
• Take vitamin supplements.
  
• Do moderate exercise.
  
• Get enough rest.
  
• Have an HIV test.

Know your status, protect your health
Knowing your status allows you to take the necessary steps to protect yourself and your baby’s health.

What is an HIV test?
An HIV test is a blood test that tells you if you are infected with the Human Immunodeficiency Virus (HIV) that causes AIDS.

Why should you have an HIV test?
An HIV test is strongly recommended to protect yours and your baby’s health.

• If you are HIV-negative, you can plan to stay HIV-negative.
  
• If you are HIV-positive:
  
• You can access care and support before you get ill.
  
• You can reduce the chance of passing HIV to your unborn baby and to others.

In South Africa, you will be asked to consent to the HIV test. You have the right to refuse. In Botswana and Zambia, when you are pregnant and visit the clinic you will be tested for HIV unless you opt out of the test.

When will you have an HIV test?
You will be offered an HIV test as soon as you book at the clinic. If you test HIV-negative, you could be in the ‘window period’. You will be offered a repeat test at 32-34 weeks (8 months).

If you test HIV-negative, plan to stay HIV-negative
You can get HIV by having sex (anal, vaginal or oral) with someone infected with HIV. If you are HIV-negative, you can take steps to protect yourself from infection:

• If you have sex, always practice safer sex by using condoms.
  
• Ask your partner to have an HIV test.
  
• Be faithful to one partner.
  
• If you have chosen to stop having sex, ask a friend you trust who has made the same decision to help you be strong and stick to this decision. See How to Abstain in Lifting the Lid on Teen Pregnancy.

These prevention measures are especially important during pregnancy. If you get infected during pregnancy, there is a high risk of passing HIV to your baby.

What does “HIV-positive” mean?
This means that you are infected with the Human Immunodeficiency Virus (HIV). HIV destroys the immune system. Early on, an infected person has no symptoms. As the infection progresses, the immune system becomes weaker, and the person can develop many different infections, including TB. AIDS (Acquired Immuno Deficiency Syndrome) is the most advanced stage of HIV infection. It can take 10-15 years for an HIV infected person to develop AIDS. Antiretroviral medicines can slow down the process.
An HIV-positive mother can pass HIV to her baby during pregnancy, delivery or through breastfeeding. Antiretrovirals can prevent mother to child transmission of HIV.

What should you do if you are HIV positive?

• Take additional care of yourself
  
• Take antiretroviral medicines to reduce the chance of passing HIV to your baby
  
• Choose the best way to feed your baby
  
• Find a support group where you can talk about it with others that have gone through a
• pregnancy and been HIV positive

HIV care in pregnancy
PMTCT treatment in South Africa, Botswana and Zambia is very similar, with slight variations on the drugs combinations used and the CD4 count at which women at given AZT.

If your HIV test comes back positive, you will be examined to see how far advanced your HIV is and have a CD4 blood test.
If your immune system is very weak (CD4 less than 250 or ‘late’ stage of HIV):

• You need antiretroviral ‘triple therapy’ to help your immune system to recover and to lower the chance of passing HIV to your baby. These three ARVs are zidovudine (AZT), lamivudine (3TC) and nevirapine.
  
• You should start treatment as early as possible in pregnancy. You will need to continue the treatment lifelong.
  
• If you are already on triple therapy, you may need to change your treatment to ARVs that are safer for your baby.

If your immune system is stronger (CD4 count above 250 in South Africa AND Botswana and 350 in Zambia):

• You do not need ARV ‘triple therapy’ yet.
  
• You should take AZT and nevirapine to lower the chance of passing HIV to your baby.
  
• AZT will be started at 28 weeks (7 months) and will continue until delivery.
  
• You will also receive nevirapine in labour in South Africa and in Botswana and Zambia you will additionally receive a combination of 3TC + AZT.
  
• After delivery, HIV+ mothers may be instructed to continue taking AZT for 7 days.
  
• If HIV+ pregnant women were not initially subject to nevirapine and AZT during pregnancy, then they may be instructed to take AZT for 28 days after delivery.

Care of babies
born to HIV+ women

All babies born to HIV-positive women will receive nevirapine and AZT after birth. You will also be provided with AZT to give the baby for 7 or 28 days (depending on your treatment).

Take your baby to the nearest clinic within 1-2 weeks after birth for follow-up care. Take your Road to Health Card and referral letter with you. Attend the clinic for all appointments, including immunisations. At 6 weeks, all HIV-positive mothers will be offered a PCR HIV test for their babies. This test will tell you whether or not your baby is HIV infected. If you breastfeed, the HIV test will need to be repeated when you stop.

All HIV-positive mothers should also receive regular care at the clinic. You and your baby can be seen at the same visit.

Infant feeding
If you are HIV-negative, breastfeed your baby as this gives your baby the healthiest start in life.

If you are HIV-positive, you need to choose to either ONLY formula feed your baby (preferable) or ONLY breast feed your baby, but NEVER mix these two options. This is because proteins in the cow’s milk of the formula irritates the baby’s gut lining creating tiny holes and increases the risk of the virus getting through. So if you formula feed and the tiny holes are created and then breastfeed and are HIV positive, there is a chance that you can pass on the virus to your child. So avoid mixed feeding at all costs in the first 6 months as this increases the chance of your baby getting HIV. Mixed feeding is combining breastfeeding with formula or other drinks
or solids.

I Choosing exclusive formula feeding

• Avoid breastfeeding transmission of HIV by exclusive formula feeding for 6 months.
  
• You can choose exclusive formula feeding if:
  
• You will be able to practice formula feeding safely (have access to clean water to wash your utensils and hands)
  
• You can boil water everyday
  Formula feeding is acceptable to your family and they will not pressure you to
• breastfeed
  
• All mothers on the PMTCT program who choose to formula feed their infants will receive free milk formula for 6 months in South Africa and formula is also dispensed at clinics in Botswana.

II Choosing exclusive breastfeeding

• If you cannot practice formula feeding safely or it is not acceptable to you or your family, you should choose to exclusively breastfeed.
  
• Give your baby only breast-milk for the first 6 months: no water, juice, other drinks or solids.
  
• After 6 months, rapidly wean the baby and give solids and milk formula.

A guy thing?

As a guy, if your girlfriend is pregnant, you have an important role to play in making sure she and the baby are healthy.
Getting tested yourself and encouraging your partner to get tested is the most important thing you can do to ensure your child’s health.
If you are HIV+ and your partner is not, she might need to go back for another test in 3 months time as she might be in the window period when HIV might not be detected. If she is HIV+, you can encourage and support her to visit the clinic regularly and listen to the advice and take the medication she is given.
Once the baby is born, you can encourage and support the mother to feed the baby correctly. She must choose either breast feeding or formula feeding, but she must NEVER mix the two as this will make the baby’s stomach more open to infection which increases its chances of contracting HIV. For more on this, read about Infant Feeding.
A real man does the right thing.

 

Information sourced mainly from the Desmond Tutu TB Centre, City Health Directorate and Western Cape Department of Health.