2016年3月22日 星期二


昨日有則新聞 : 愛滋媽可餵母乳?疾管署打臉國健署 !

到底孰是孰非 , 我們來看看WHO(世界衛生組織)的建議 , 原文中提到 :

Breastfeeding, and especially early and exclusive breastfeeding, is one of the most significant ways to improve infant survival rates. However, HIV can pass from mother to child during pregnancy, labour or delivery, and also through breast milk. In the past, the challenge was to balance the risk of infants acquiring HIV through breastfeeding versus the higher risk of death from causes other than HIV, in particular malnutrition and serious illnesses such as diarrhoea and pneumonia, among HIV-exposed but still uninfected infants who were not breastfed.

The evidence on HIV and infant feeding shows that giving antiretroviral drugs (ARVs) to HIV-infected mothers can significantly reduce the risk of transmission through breastfeeding and also improve her health. This enables infants of HIV-infected mothers to be breastfed with a low risk of transmission (1-2%). HIV-infected mothers and their infants living in countries where diarrhoea, pneumonia and malnutrition are still common causes of infant and child deaths can therefore gain the benefits of breastfeeding with minimal risk of HIV transmission.

Since 2010, WHO has recommended that mothers who are HIV-infected take ARVs and exclusively breastfeed their babies for 6 months, then introduce appropriate complementary foods and continue breastfeeding up to the child’s first birthday. Breastfeeding should only stop once a nutritionally adequate and safe diet without breast milk can be provided.

Even when ARVs are not available, mothers should be counselled to exclusively breastfeed for 6 months and continue breastfeeding thereafter unless environmental and social circumstances are safe for, and supportive of, feeding with infant formula.

裡面有幾個重點資訊 :

1. 愛滋病毒可能透過孕程、產程及哺乳傳給胎兒。

2. 透過給予母親抗病毒藥物可以大幅減少寶寶被傳染的機率至2%以下

3. 在衛生條件較差 , 腹瀉、肺炎及營養不良仍舊威脅嬰兒生命的國家 , 哺乳仍舊是獲得食物來源的首選。

所以 , 愛滋媽媽是否該鼓勵哺乳?

在寶寶無法獲得安全食物的國家 , 建議盡可能給母親使用抗病毒藥物降低傳染風險 , 母親持續哺乳至嬰兒能獲得足夠且安全的營養來源。並依循六個月後添加適當副食品原則。

而在台灣 , 衛生環境與疫苗保護的建構相對完整 , 嬰幼兒獲得安全足夠營養較受到保障 , 雖然孕婦體檢常規篩檢愛滋病 , 可早期用藥防範疾病傳染 , 健保體系對於患者使用抗病毒藥物也相對便利 , 但因無法確保嬰幼兒經由哺乳傳染愛滋病的風險 , 目前並不建議愛滋媽媽哺餵母乳。

經由篩檢來確定嬰幼兒是否遭受感染是否可行?由於嬰幼兒出生六個月內體內還有來自母親的抗體 , 容易造成檢驗結果判讀有誤 , 目前並不建議依照篩檢結果來決定母親是否可以哺乳。