HIV AND PREGNANCY

Since 1990 216 HIV-infected pregnant women have been enrolled in an on going nationwide study named ''HIV and Pregnancy'' financed by the Swi ss Federal Office of Health (No. 90-7007 and 93-7131). Of a total of 2 28 recorded pregnancies 154 continued to parturition. Until now it has been definitively established whether or not 89 offsprings have been infected with HIV by their mothers. According to clinical and immunolo gical findings most of the pregnant women are still in early, stable s tages of HIV-infection (stages II and III of the CDC classification sy stem in 94% of the subjects; mean CD4-cell count around 600/mu l). HIV infection was the consequence of an intravenous substance abuse in tw o thirds of the women. Detailed interviews revealed an alarming neglig ence with regard to compliance with safer sex recommendations and cont raception. Advisory services of specialized AIDS information centers h ave very rarely been called on. In our group, the vertical transmissio n rate shows a statistically significant correlation with low maternal anti-HIV-p24 antibody titers, high serum neopterin- and IgA-concentra tions, and also with the use of forceps and vacuum in vaginal delivery . Maternal substance abuse but not HIV infection itself resulted in an incidence of preterm deliveries roughly twice as high as in the norma l Swiss population.