United Press International - Wednesday, 2 May 2001
Ed Susman, UPI Science News

"I was opposed to the law that requires testing," said Dr. Urania Magriples, associate professor of obstetrics and gynecology at Yale University School of Medicine, New Haven, Conn. "But the law does work."

At the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) here, researchers said the Connecticut law requiring prenatal testing of mothers, or post-delivery testing of newborns, has led to almost universal testing for a pregnant woman's HIV status. Infection by the human immunodeficiency virus, or HIV, leads to AIDS in people.

Magriples said the law, which went into effect in October 1999, coerces women into allowing the tests to be performed. But her study at Yale found that before the study less than 40 percent of women underwent testing and after the law more than 95 percent of women allowed themselves to be tested for the disease.

In a study conducted at Stamford Hospital in Connecticut, Dr. William Cusick, assistant clinical professor of obstetrics and gynecology at Columbia University in New York, said mandatory testing uncovered seven pregnant women who were apparently unaware they had HIV. Those women were started immediately on highly active antiretroviral therapy (HAART), a combination of anti-HIV drugs, and all delivered babies that were free of disease and continued to be free of the virus a year later. More than 2,300 children were born at the hospital during the period of the study, October 1999 to July 2000.

The testing also led to the discovery that two other persons -- a child and the spouse of one of the infected women -- were also infected. Treatment for them also was started.

Based on a natural history of the disease in which about 30 percent of babies of infected mothers carry the virus from birth, Cusick estimated that mandatory testing saved two babies from becoming infected at his hospital, which includes children from all over Fairfield County in Connecticut and parts of Westchester County in New York.

"Being able to save one child in nine months is worth it, I think," Cusick said. "There are few times in medicine you can prevent a lethal disease."

He said that when women are told that they must submit to the testing -- except for religious grounds -- most of them do not object.

Magriples concurred. Very few women signed a form refusing to allow the testing, she said. Among those who originally refused (about 10 percent of the total), half of those women agreed to testing when counseled later.

"I believe they realized that the tests were to benefit their child and that's why they consented," she said. The nearly universal testing has found about 10 more infected pregnant women that would have been expected historically, she said. Prior to the testing law, about 15 pregnant HIV infected women were seen at Yale yearly; since the law, the staff sees about 25 infected women annually.

ACOG, which represents 40,000 obstetricians and gynecologists, and the American Academy of Pediatrics, in a 1999 policy statement, called for universal HIV testing of pregnant women, but did not support mandatory testing.

Cusick said that Connecticut -- the only state that mandates testing -- has led the way in counseling and testing for HIV, and the studies presented at ACOG show that "a policy of mandatory HIV prenatal screening is achievable and desirable."
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