Has been done badly in Britain and needs to improve

The advantages of ascertaining a pregnant woman's HIV positive status before delivery are clear: transmission to the baby can be roughly halved by avoiding breast feeding1 and reduced by a further two thirds by the administration of zidovudine.2 Yet, as several papers in this week's issue show, in Britain we are failing to test pregnant women for HIV and, as a result, to reduce the rate of vertical transmission.

Undoubtedly there are psychological and social disadvantages to a woman in discovering that she is HIV positive, but these will inevitably occur at some time. The advantages of knowing are particularly great in pregnancy. As well as through avoiding breast feeding and using zidovudine, further reductions in the risk of transmission may be possible by offering caesarean section,3 using other antiretrovirals, and avoiding invasive procedures during vaginal delivery. The paper by Lyall et al shows that women will take these measures to prevent transmission (p 268).4 Some women may choose to terminate their pregnancy,5 and all can make informed decisions about further pregnancies: on p 271 Richardson and Sharland show that in many mothers infection is not diagnosed until their child has reached 1 year of age, …