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SOGC Policy Statement
CLINICAL
PRACTICE
GUIDELINES
saGe POLICY STATEMENT*
HIV TESTING IN PREGNANCY This Policy Statement has been prepared by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada and approved by its Council in June 1995. MATERNAL FETAL MEDICINE COMMITTEE:
Chair: Dr. Robert Liston, MD, FRCSC Past Chair: Dr. Renato Natale, MD, FRCSC Members: Dr. Karen Ash, MD, FRCSC Dr. George Carson, MD, FRCSC Dr. Greg Connors, MD, FRCSC Dr. Line Leduc, MD, FRCSC Dr. Douglas McMillan, MD, FRCPC Dr. Patrick Mohide, MD, FRCSC
RATIONALE
The prevalence of HIV seropositivity in women of childbearing age varies throughout Canada (1.13/10,000 in Nova Scotia, 15.2/10,000 in Montreal). Such variation will affect the acceptability and the cost effectiveness of universal screening. Furthermore, the current SOGC recommendations on pretest counselling will have significant effects on the practicality of universal screening. 1 This issue highlights the generic question of pretest counselling with respect to all aspects of prenatal screening - or testing.
(Halifax, NS) (London, ON) (Ottawa, ON) (Regina, SK) ( Calgary, AB) (Montreal, QC) ( Calgary, AB) (Hamilton, ON)
RECOMMENDATIONS
In light of the above, the Maternal Fetal Medicine Committee of the SOGC makes the following recommendations: a) Individuals providing prenatal care to pregnant women should be aware of the efficacy of Zidovudine treatment during pregnancy in reducing vertical transmission to the offspring of pregnant women who are HIV positive. b) Providers of care to pregnant women should be alert to the possibility of HIV infection and should screen, with consent and with due regard to confidentiality, those thought to be at risk. 1
INTRODUCTION
The increasing rates of HIV infection in women,I.2 the potentially devastating effect on the neonate of vertical transmission from the mother,3 and the proven efficacy of Zidovudine in reducing vertical transmission,4 lend support to the concept of offering HIV screening to every pregnant woman during pregnancy. Such a recommendation has been made by the Infectious Disease Committee of the Canadian Paediatric Society.s A similar recommendation has been made by the American Academy of Pediatrics. 6
*Policy Statements: This policy reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level.
JOURNAL SOGC
171
FEBRUARY 1996
, , , c) Women so screened and found to be positive should be counselled by an expert individual. d) HIV positive women should be offered treatment with Zidovudine as currently recommended. 4 e) Further research on the cost effectiveness of universal screening in Canada is warranted. f) Review of existing recommendations on pretest counselling with respect to HIV screening is warranted, to bring such testing in keeping with other forms of prenatal screening. g) Universal screening of pregnant women in clearlydefined geographic populations with an increased incidence of HIV seropositivity may be warranted at this time.
J SOGe
1996;18:171-72
REFERENCES 1.
2.
Centers for Disease Control and Prevention. Update: Acquired Immunodeficiency Syndrome - United States 1992. MMWR 1993; 42:547-51, 557. Ellerbrock TV, Bush TJ, Chamberland ME, Oxtoby MJ. Epidemiology of women with AIDS in the United States, 1981 through 1990. A comparison with heterosexual men with AIDS. JAMA 1991; 265:2971-5.
SUGGESTED READINGS 3.
4.
5.
6.
7.
Sperling RS, Stratton P, O'Sullivan MJ, Boyer P, Watts DH, Lambert JS et al. Survey of Zidovudine use in pregnant women with human immunodeficiency virus infection. New Engl J Med 1992; 326:857-61. Centers for Disease Control and Prevention. Zidovudine for prevention of HIV transmission from mother to infant. MMWR 1994; 43:285-7. Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Should there be routine testing for human immunodeficiency virus infection in pregnancy? Can J Infect Dis 1994; 5:203-4. Provisional Committee on Pediatric AIDS. Perinatal human immunodeficiency virus testing. Pediatr 1995; 95:303-7. Society of Obstetricians and Gynaecologists of Canada, Clinical Practice Guidelines for Obstetrical and Gynaecological Care of Women Living with HIV, 1994.
JOURNAL SOGe
172
FEBRUARY 1996
PRACTICE
GUIDELINES
saGe POLICY STATEMENT*
HIV TESTING IN PREGNANCY This Policy Statement has been prepared by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada and approved by its Council in June 1995. MATERNAL FETAL MEDICINE COMMITTEE:
Chair: Dr. Robert Liston, MD, FRCSC Past Chair: Dr. Renato Natale, MD, FRCSC Members: Dr. Karen Ash, MD, FRCSC Dr. George Carson, MD, FRCSC Dr. Greg Connors, MD, FRCSC Dr. Line Leduc, MD, FRCSC Dr. Douglas McMillan, MD, FRCPC Dr. Patrick Mohide, MD, FRCSC
RATIONALE
The prevalence of HIV seropositivity in women of childbearing age varies throughout Canada (1.13/10,000 in Nova Scotia, 15.2/10,000 in Montreal). Such variation will affect the acceptability and the cost effectiveness of universal screening. Furthermore, the current SOGC recommendations on pretest counselling will have significant effects on the practicality of universal screening. 1 This issue highlights the generic question of pretest counselling with respect to all aspects of prenatal screening - or testing.
(Halifax, NS) (London, ON) (Ottawa, ON) (Regina, SK) ( Calgary, AB) (Montreal, QC) ( Calgary, AB) (Hamilton, ON)
RECOMMENDATIONS
In light of the above, the Maternal Fetal Medicine Committee of the SOGC makes the following recommendations: a) Individuals providing prenatal care to pregnant women should be aware of the efficacy of Zidovudine treatment during pregnancy in reducing vertical transmission to the offspring of pregnant women who are HIV positive. b) Providers of care to pregnant women should be alert to the possibility of HIV infection and should screen, with consent and with due regard to confidentiality, those thought to be at risk. 1
INTRODUCTION
The increasing rates of HIV infection in women,I.2 the potentially devastating effect on the neonate of vertical transmission from the mother,3 and the proven efficacy of Zidovudine in reducing vertical transmission,4 lend support to the concept of offering HIV screening to every pregnant woman during pregnancy. Such a recommendation has been made by the Infectious Disease Committee of the Canadian Paediatric Society.s A similar recommendation has been made by the American Academy of Pediatrics. 6
*Policy Statements: This policy reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level.
JOURNAL SOGC
171
FEBRUARY 1996
, , , c) Women so screened and found to be positive should be counselled by an expert individual. d) HIV positive women should be offered treatment with Zidovudine as currently recommended. 4 e) Further research on the cost effectiveness of universal screening in Canada is warranted. f) Review of existing recommendations on pretest counselling with respect to HIV screening is warranted, to bring such testing in keeping with other forms of prenatal screening. g) Universal screening of pregnant women in clearlydefined geographic populations with an increased incidence of HIV seropositivity may be warranted at this time.
J SOGe
1996;18:171-72
REFERENCES 1.
2.
Centers for Disease Control and Prevention. Update: Acquired Immunodeficiency Syndrome - United States 1992. MMWR 1993; 42:547-51, 557. Ellerbrock TV, Bush TJ, Chamberland ME, Oxtoby MJ. Epidemiology of women with AIDS in the United States, 1981 through 1990. A comparison with heterosexual men with AIDS. JAMA 1991; 265:2971-5.
SUGGESTED READINGS 3.
4.
5.
6.
7.
Sperling RS, Stratton P, O'Sullivan MJ, Boyer P, Watts DH, Lambert JS et al. Survey of Zidovudine use in pregnant women with human immunodeficiency virus infection. New Engl J Med 1992; 326:857-61. Centers for Disease Control and Prevention. Zidovudine for prevention of HIV transmission from mother to infant. MMWR 1994; 43:285-7. Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Should there be routine testing for human immunodeficiency virus infection in pregnancy? Can J Infect Dis 1994; 5:203-4. Provisional Committee on Pediatric AIDS. Perinatal human immunodeficiency virus testing. Pediatr 1995; 95:303-7. Society of Obstetricians and Gynaecologists of Canada, Clinical Practice Guidelines for Obstetrical and Gynaecological Care of Women Living with HIV, 1994.
JOURNAL SOGe
172
FEBRUARY 1996