[HIV seropositivity and desire for children]. / Seropositive VIH et desir d'enfant.

PIP: The number of women who learn of their HIV seropositivity and still want to have a child is growing. If the woman is HIV seropositive, pregnancy is not advised, but it is difficult if not impossible to prevent a young woman from a having wanted child. No rational argument can suppress this desire that the life-threatening illness exacerbates. The counselor must consider the clinical and immune status of the mother, the serostatus and health status of the partner, and the likelihood of family members raising the child. If the woman is HIV seronegative and her partner is HIV seropositive, the counselor must first make sure that the women does not seroconvert and that her desire for a child is real. Then the counselor must evaluate the partner's clinical and immune status. The risk of HIV transmission to the woman increases with the degree of immune suppression of the partner. It is also important to determine the stability of the discordant couple because about 33% separate after childbirth. It is only after having analyzed all these elements that the counselor and the couple can consider one of the proposed solutions. Since techniques of sperm decontamination having not yet been established, the decision is boiled down to extreme solutions: artificial insemination with sperm from an HIV negative donor or, after a spermogram and hysterography, the natural method involving intercourse only during successive periods of ovulation. The partner needs to take zidovudine to reduce the amount of sperm ejaculated. In case of pregnancy, it is necessary to recognize seroconversion, an indication for AZT. ELISA and studies on p24 antigenemia must be conducted each month of the pregnant woman. Couples must continue to use condoms after the delivery because a seroconversion would nullify all earlier efforts. Breast feeding can transmit HIV to the infant. Professional guidelines forbid tubal infertility surgery and in vitro fertilization in couples where the woman or man is HIV infected. The opinion of the French National Ethics Commission will be sought on less invasive infertility therapy.^ieng

[HIV seropositivity and desire for children]. / Séropositivé VIH et désir d'enfant.

Growing numbers of women and men who are HIV infected and aware of their serostatus, want to have children. Gynecologists are involved in the dilemmas of counseling those couples about reproductive decisions. For HIV infected women, pregnancy is contra-indicated, mostly because of the risk of transmission to the fetus/infant. However, no rational argument can abolish the desire of many young women to have children in the face of the life-threatening infection. The clinical and immune status of the would-be mothers, her partner's serostatus and the availability of family members to rear an orphaned child, must be considered. For seronegative women with HIV-infected partners, after confirming that seroconversion is not occurring, the partner's clinical and immune status must be evaluated. The risk of transmission through unprotected intercourse increases with the degree of immune suppression in the partner. The couple's stability and the woman's motivations for becoming pregnant must also be carefully evaluated. About one third of such discordant couples separate after the birth of their child. For selected couples who have clearly decided to attempt pregnancy, the objective of reproductive counseling is to reduce their risk of heterosexual transmission. The partner's sperm should not be used for insemination because techniques have not yet been established to eliminate HIV from sperm preparations. Insemination with HIV-negative donors' sperm can be considered. An alternative is the "natural" method, consisting in having unprotected intercourse only during ovulation. Administration of zidovudine to the man in order to reduce the amount of virus excreted has been discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Routes of HIV infection in a pregnant population in metropolitan France: evolution over a three year period]. / Evolution du mode contamination par le VIH des femmes enceintes en France métropolitaine.

Routes of HIV transmission among seropositive pregnant women were studied over a three year period in a nationwide multicenter study in France. A total of 2,346 cases were included: 666 in 1987, 809 in 1988 and 871 in 1989. The principal route of transmission was intravenous drug use (IVDU), however an increase in heterosexual transmission was observed. From 1987 to 1989, the proportion of cases related to IVDU decreased from 66.4 percent to 48.2 percent while sexually transmitted cases increased from 24.9 percent to 41.8 percent. The trend towards heterosexual transmission among pregnant women was more marked in the Paris region than in the rest of France. This tendency may be overestimated because of changes in population, such as an increase in women from sub Saharan Africa, the extension of serodiagnosis among IVDU and the extension of systematic testing of pregnant women over the study period. Heterosexual transmission of HIV does appear to be increasing in Europe as can be observed among female AIDS cases.

[Epidemiological study of 200 HIV infected pregnant women]. / Etude épidémiologique de 200 femmes enceintes infectées par le VIH.

Demographic characteristics and lifestyle were studied among 200 HIV-seropositive women followed in a tertiary care obstetrics/gynecology center in Paris. Between 1985 and 1989, a detailed questionnaire was run by a specialized midwife. The study group, mostly comprised of pregnant women, was compared with the women delivering in the department and with the overall French pregnant population. The women's partners were also studied. There appeared to be a core group of women who are young, single, often unemployed, marginalized members of foreign-born minorities, heavy smokers, and past or present intravenous drug users. Among their partners, drug use was frequent; over half were born in sub-Saharan Africa or North Africa and one third were unemployed. Among women having a job, white collar employees and service workers were over represented, whereas blue collar workers were under represented. The epidemiological profile of HIV-infected women appears to be very different from that of the largely homosexual male population in France. These women are younger and often less intellectual, poorer, more socially marginalized and less receptive to campaigns for prevention. However, the majority of our patients are married or live maritally, work and do not (presently) use drugs.

[HIV-infected women's decision to continue or terminate pregnancy]. / Attitude des femmes enceintes infectées par le VIH.

Our purpose was to determine how women's knowledge of HIV seropositivity influenced their decision on whether to continue pregnancy. The study included 2,023 pregnant women from 220 maternities through France, 595 in 1987, 691 in 1988 and 737 in 1989. Approximately one half decided to continue pregnancy. This proportion was higher in the Paris region (58.9 percent) than in the other regions of France (38.2 percent). Motivations for continuing pregnancy included a visceral desire to have a child, a means of transcending one's mortality, a gift to the partner, a means of rehabilitation, a denial of the pathologic state or the conviction that the infant will be unaffected. Motivations for terminating pregnancy included fear of contaminating the infant, fear that pregnancy could accelerate their own disease progression and fear that the infant will become orphaned. The attitude of physicians towards pregnancy in HIV infected women is discussed. The discovery of an effective treatment decreasing materno-fetal transmission and/or an approach to prenatal diagnosis could offer solutions to this difficult dilemma.

[Early amniocentesis, 1061 punctures and 1000 pregnancies]. / L'amniocentèse précoce. 1061 ponctions et 1000 grossesses.

The authors analysed 1061 early amniocentesis carried out during 1000 pregnancies. The indications were as follows: chromosomal abnormalities (79,6 p. 100), fetal karyotypes for X-linked diseases (4,7 p. 100), metabolic disorders (5,9 p. 100), amniotic fluid alpha-foetoprotein (9,8 p. 100) in neural tube defect or congenital nephrosis. Amniotic fluid was obtained on the first attempt in 98.2 p. 100 and on the second attempt in 100 p. 100. The fluid was heavily blood-stained in 1,7 p. 100, sanguinolent in 3,8 p. 100 and brownish in 2,40 p. 100. Cells were grown on the first attempt in 98 p. 100 and on the second attempt in 100 p. 100. The outcome of pregnancies was correlated with the indications of amniocentesis. The rate of spontaneous abortion is 1,7 p. 100, but only 6 of them can be due to amniocentesis (0,6 p. 100). Perinatal mortality was 1,8 p. 100: mortinatality (1,2 p. 100) and neonatal mortality (0.6 p. 100). All this fetal deaths have other causes. The fetal loss was 3,9 p. 100. Fetal morbidity was low: none fetal injuries, none cutaneous scar, few premature deliveries (1,6 p. 100), some malformations more or less serious (2,6 p. 100) with 4 congenital luxations of the hips (0,45 p 100). Maternal morbidity was limited at a greater cesarean section rate: 21 p. 100 (30 p. 100 in women 40 years old and more), none feto-maternal rhesus immunization was observed because immunoprophylaxis was strictly performed. The rate of therapeutic abortion was 4,6 p. 100 without any diagnostic error. Diagnostic accuracy was 100 p. 100. Several conditions are necessary to be the procedure safe accurate and reliable: appropriate genetic counseling, exact determination of gestational age (17 international weeks), sufficient volume of amniotic fluid counseling, exact determination of gestational age (17 international weeks), sufficient volume of amniotic fluid (uterus size: 12 cm), gynecologic examination by operator himself, perfect echography to localize the placenta and detect multiple gestations, adequately trained obstetrician, use of 20 gauge spinal needle, stric asepsis, experimented laboratory and experienced staff.