Thursday, September 11, 2014

Vertical infections

Advice - Mind, Body and Family, Sep '14
By Dr. Tirthankar Guha Thakurta

After sexually transmitted infections (STIs) and reproductive tract infections, it is time to take a look at mother to child infections. Several infections can be transmitted from a mother to her child. The infections can be transmitted not only during pregnancy, but also during the process of childbirth or breast-feeding. Let’s take a look at some of the common infections that can pass down from mother to child.

What does the term vertical infection mean?
An infection that can pass down from a mother to her child is called vertical infection. Vertical infections include HIV, syphilis, gonorrhoea, cytomegalovirus, toxoplasma, among many others.

Artwork: Clip Art from MS Office
How does a woman know that she has any one of the above infections during pregnancy?
In some cases, there may be symptoms specific to the disease. Many times, however, the maternal infection is asymptomatic. The only way to detect a maternal infection is to do an intuitive (or routine) screening. It is actively encouraged that all mothers are tested for HIV infection during (and if possible before planning) pregnancy. Besides, a VDRL test can screen latent syphilis infection. Sometimes doctors advise a group of tests called TORCH screen. It is an acronym for toxoplasma, rubella, cytomegalovirus and herpes simplex – four serious maternal infections that can affect the growing foetus.

What are the complications of a pregnant woman getting these infections?
Many of the above infections can cause multiple congenital defects in the child. The defects vary with the individual infections and include deafness, heart anomaly, visual defects, bone and teeth defects, and in case of HIV infection, the infection itself.

What is the way out if a pregnant woman is diagnosed HIV positive?
Many good medicines can prevent the transmission of HIV from the pregnant woman to the developing foetus. Drugs like nevirapine and zidovudine have revolutionised prevention of vertical transmission of HIV.

Should a mother who is HIV positive be advised normal delivery?
Normal delivery carries higher chances of bleeding wounds. A large number of infections are transmitted from mother to child during childbirth by normal delivery. Caesarean sections cause minimum trauma in terms of bleeding and exposure of the child to maternal blood. It is advocated that in the absence of other contra-indications, Caesarean section is a better delivery option for HIV positive pregnant women.

Can a mother who is HIV positive breastfeed her child?
Yes and no. Breast milk does carry some (though little) risk of transmitting HIV from mother to child. In developed countries, where replacement feeding options (infant formula feed) are viable, HIV positive mothers are not encouraged to breastfeed their newborns. However, in India, where replacement feeding is challenged by factors like contaminated water and hygiene, more children will die of diarrhoea and malnutrition if breastfeeding is discouraged. The risk of transmission of HIV in poorly developed countries is far less than the risk of death due to malnutrition and diarrhoea. Thus, decisions on breastfeeding are made on a case-to-case basis by weighing the risks and benefits of breastfeeding.

How do we prevent mother to child transmission of infections?
The best way is for a woman to screen herself voluntarily while planning pregnancy and during pregnancy. Her male sexual partner must also be encouraged to test for HIV and other STIs, as these infections can pass on from him to the woman sexually before pregnancy or at any stage of pregnancy.

For more information on vertical infections and their prevention or treatment, don’t hesitate to write to us at the contact information given below. For information on government facilities for prevention of mother (parent) to child transmission of HIV, click here. This link will provide a state wise list of Integrated Counselling and Testing Centres in India, which provide counselling, testing and guidance for prevention of mother to child transmission of HIV.

Confused? Disturbed? Just inquisitive? Write in any query on the mind, body and family to, and Dr. Tirthankar Guha Thakurta, teaching faculty at a Kolkata-based medical college, will be happy to answer them – with due respect to confidentiality.

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