[Pregnant women with HIV infection: medical decision]

The aim of this study was to review current knowledge of mother-to-fetus transmission of human immunodeficiency virus (HIV) and attempt to determine a rationale for decision making in infected women. The risk of transmission to the fetus varies from 20% for women with stage II infection to 50% in stage IV patients. The risk can be reduced to 8% with zidovudine (in stage II patients). Knowledge of the prevalence of HIV infection in women in different risk groups and geographic areas is important in evaluating risk; currently 80 to 500 infants are contaminated annually in France. Although clinical signs and laboratory results may be suggestive of late transmission, neither the mechanism nor the precise period of transmission are known. HIV-infection has no effect on the natural course of pregnancy. Screening tests should be performed for all pregnant women, but are not mandatory. A positive test should always be announced by the physician. The decision to continue the pregnancy must be based on several factors: term, disease severity and socioeconomic situation. If the pregnancy is continued, zidovudine (5 x 100 mg) should be prescribed through delivery. To date, there is no evidence favoring cesarean rather than vaginal delivery. Two steps are required for the infants: zidovudine for 6 weeks and artificial feeding. Social and psychological obstacles hinder progress in limiting disease transmission from mother to infant.