KHOPOTSO: Pregnant women are strongly advised to attend ante-natal care clinics very early on in their pregnancy. This would help them to find out their HIV status and if positive, to avoid or treat any illness that can be induced by pregnancy. In a study conducted by Wits University’€™s Department of Nursing Education, it was found that HIV-positive pregnant women are more prone to illness. Dr Candice Bodkin is the researcher in the study.

Dr CANDICE BODKIN: We found that HIV-positive women were more likely to have anaemia in pregnancy. Now, anaemia in pregnancy is not unexpected in South Africa. It is related to bad nutrition, bad ante-natal care. But it was definitely more significantly increased in the HIV-positive woman. It could be related to anaemia of chronic diseases, which is not unexpected in HIV-positive women. They do have anaemia even before they become pregnant. It could also be because of chronic diarrhoea and mal-absorption in HIV-positive pregnant women. The problem with anaemia is that it doesn’€™t necessarily cause increased death on its own, but if this woman has a post-partum bleed, for instance, she’€™s at much more risk of mortality because she can’€™t tolerate that bleed because of the anaemia.                      

KHOPOTSO: Bodkin continues.

Dr CANDICE BODKIN: HIV-positive women were far more likely to have bladder infections. Bladder infections are not so rare in pregnancy’€¦ but (with) HIV their immune system is slightly lower. They’€™re more at risk of getting bacterial infections that their bodies can’€™t fight off naturally, and that’€™s why they’€™re at greater risk of urinary tract infections’€¦ The other one was sexually transmitted infections. It’€™s not unknown that a sexually transmitted infection like chlamydia or gonorrhoea or herpes increases the risk of a woman getting HIV. So, it’€™s not unexpected that we would find sexually transmitted infections in HIV-positive women.        

KHOPOTSO: The study also found that HIV had an impact on both mothers and their babies.

Dr CANDICE BODKIN: Our patients were fairly advanced. Their CD 4 counts were low’€¦ And as a result they didn’€™t gain weight adequately. And as a result of the mother being ill the babies were likely to be compromised ‘€“ to be small for gestational age and to be of low birth weight. We would expect a baby to weigh about 3kg, but anything from about 2.8 up until about 4.1 kg. It seems to be, from the findings of this study, that the babies born to HIV-positive mothers had a negative effect in every aspect.

They were born slightly earlier, they were slightly smaller, they were slightly more likely to be smaller or experience intrauterine growth retardation’€¦ And the danger of a pre-term baby and the dangers of low birth-weight babies is the risk of mother to child transmission is increased in these particular babies, which is of grave concern.    

KHOPOTSO: Abnormally high hypertension levels, the second leading cause of maternal death after HIV in South Africa, were also recorded among the pregnant HIV-positive women. The study was conducted in 2003 at Johannesburg Hospital on just over 200 pregnant HIV-positive women who were matched with 100 pregnant HIV-negative women. Bodkin says the results re-enforce the importance of why women should attend ante-natal clinics early on in their pregnancies.  

Dr CANDICE BODKIN: For HIV-positive women it’€™s not the end. I think that it’€™s a positive thing for HIV-positive women that they can understand that if they are pregnant they should attend ante-natal clinic(s) as soon as they understand that they are pregnant. They have a CD4 count done, which means we can establish how far the HIV has progressed. If they qualify for antiretroviral therapy, they start the antiretroviral therapy as soon as possible. If they don’€™t, they can have Nevirapine given to them at the onset of labour. The importance of that is to prevent mother to child transmission of HIV. Also, if they have good ante-natal care the care-giver can prevent any of these complications from happening – reduce the risk of them happening. So, an HIV-positive woman can still have a normal pregnancy with good ante-natal clinic care.