Clinical Manual for Management of the HIV-Infected ... - myCME.com

Patient Education
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Reinforce regularly and clearly the notion that,
when the mother cares for herself, she is caring for
her infant. Talk with the patient about stress, the
importance of adequate mild-to-moderate exercise,
and sufficient rest.
Emphasize that regular prenatal care is extremely
important to prevent complications of pregnancy.
Use of a prenatal vitamin supplement is important,
but cannot replace healthy food intake. Develop a
plan with the patient for attaining the desired weight
gain during pregnancy, while maintaining a healthy
nutritional intake.
Cigarette, alcohol, and drug use contribute to poor
maternal nutrition and can harm the developing
fetus. Illicit drug use also increases the risk of
transmitting HIV to the infant. Injection drug use
can transmit hepatitis B and C and cytomegalovirus
(CMV) to the mother as well as to the baby.
Encourage cessation of cigarette, alcohol, and drug
use, and offer referrals for treatment, as needed.
Be sure the woman understands all planned
procedures and treatments and understands their
potential risks and benefits both to herself and to the
fetus.
Discuss the risks and benefits (to the woman
and fetus) of each medication to be taken during
pregnancy, including those for which there are
limited data on teratogenicity.
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Section 3—Antiretroviral Therapy | 3–49
Discuss ART as part of the strategy to reduce the
risk of perinatal HIV transmission to the newborn.
Allow the woman to choose whether to add ZDV
to her combination ARV regimen (if applicable), or
take it alone. The risk of developing ZDV-resistant
HIV should be discussed if ZDV is used alone.
For women at risk, diligent use of "safer sex" during
pregnancy is important to prevent STDs and CMV,
which can cause more complications when HIV is
present. STDs can harm fetal development and may
increase the risk of HIV transmission to the baby.
New genital herpes infections during pregnancy
can cause severe complications and even death in
neonates.
For women with negative Toxoplasma titers, explain
the need to avoid undercooked meats, soil, and
animal feces.
Teach the pregnant woman how to obtain medical
attention quickly at the first signs of OI or other
complication. Discuss what to watch for and how to
get help when emergencies arise in the evenings or
on weekends or holidays.
Help the patient clarify her child care options
and encourage her to begin putting in place longterm
child care and guardianship plans in case she
becomes too sick to care for her child or children.