Women who use drugs and prevention of mother to child transmission

All pregnant women should be offered screening for blood-borne viruses (BBVs); interventions to prevent mother to child transmission should be immediately offered in case of positive results. In the case of screening for BBVs during pregnancy there is no need for detailed pre-test counselling, but in case of positive results, good post-test counselling and support are essential, in order to make women aware of their condition and the related impact on their lives, and to ensure linkage to care and treatment to protect their health and prevent the mother to child transmission (MTCT).

Hepatitis and vaccination

Pregnancy is not discouraged for women living with hepatitis C. The risk of maternal-fetal transmission of viral hepatitis during pregnancy is relatively low. It is essential to note that the risk greatly increases if the mother is co-infected with HIV. Hepatitis B virus (HBV) vertical transmission rates are around 10–20% for most women co-infected with HIV. The screening for Hepatitis B - (HBV) surface antigen identifies women who are infectious; the immunization of newborns prevents vertical transmission of HBV from the mother to her baby.

WUD should be offered combined immunization against HBV (Hepatitis B) and HAV (Hepatitis A), since immunization is safe during pregnancy. An accelerated vaccination regime is recommended – vaccinating at 0, 1 and 2 months or even 0, 7 and 21 days. After having accelerated regime, another booster dose is required at month 12.

The HBV vaccine is beneficial for all babies and, provided that the baby is immunized at birth, breastfeeding is not contraindicated. Although the hepatitis B and C viruses have been found in breast milk, HCV is not transmitted through breast milk. Most experts agree that it is safe for women with hepatitis C to breastfeed their babies if specific precautions are followed. For example, if the mother has cracked and bleeding nipples, breastfeeding should be stopped until the nipples have healed and bleeding has ceased.

As yet there is no vaccine available for HIV or HCV.

WUD living with HIV

WUD living with HIV should receive special, multidisciplinary care, especially when they learn about their HIV status during pregnancy. The following services need to be put in place:

• Specific counselling and possibly peer support on HIV related issues, in order to sustain adjustment and coping with the new condition in a delicate phase of their lives.
• Interventions to reduce risk of vertical transmission from mother to baby.
• Counselling and support for treatment adherence, correct nutrition, parental training, stabilization of drug use and OST.
• Antenatal and intrapartum antiretroviral HIV treatment, along with antiretroviral treatment for the newborn.
• Delivery by Caesarean Section in selected cases.