Substance Misuse in Pregnancy - NHS Lothian

Management of HIV positive pregnant women
The care offered to HIV positive pregnant women in Lothian is jointly
managed by specialists from Midwifery, Obstetrics, HIV, Paediatrics,
Primary Care and other services (e.g. social work, drug and HIV services).
Health care staff should refer to the agreed management protocol and
care pathway. The approach to treatment is individualised, according to
the needs and choices of each mother. Good liaison is required between all
professionals to ensure that the pregnancy and birth plan proceed
appropriately and that the views and wishes of the woman are respected.
There are two scenarios in which HIV infection may be identified during
pregnancy. The first is where HIV infection is diagnosed during
pregnancy, normally at the antenatal clinic. The second is where a known
HIV positive woman falls pregnant.
Antiretroviral drug therapy (ART) for the mother aims to reduce her viral
load to ‘undetectable’. ART is given according to the mother’s HIV health
status. Normally it is avoided in the 1 st trimester. If possible, treatment
will be deferred until just before the 3 rd trimester (20-24 weeks) in
order to reduce fetal exposure. Women who become pregnant whilst
taking ART that is successfully suppressing viral load, will normally
continue with their ART throughout pregnancy.
The recommended mode of delivery is also dependent on viral load.
Caesarean section is recommended if the viral load result is >1000. If the
viral load is