Pregnancy and HIV disease
Issues that positive women may face when they're pregnant
August 2005 View PDF En
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Frequently asked questions
about HIV and pregnancy ...
Can I become a mother if I’m HIV-positive?
Yes! Especially with the development and advances in HIV research
and treatment, more HIV-positive women are choosing to conceive
or continue with their pregnancies. HIV treatment can benefit your
own health and also greatly reduce the risk of passing HIV to your
infant.
Will pregnancy make my HIV disease worse?
No. Pregnancy does not affect the course of HIV disease. It will
not make your HIV worse or better. During pregnancy, there’s
a normal drop in CD4+ cell counts that usually rebounds after birth
to pre-pregnancy levels. This is normal for any woman, regardless
of HIV status. However, if your CD4+ cell count falls below 200,
you are at a higher risk for OIs.
Can I breastfeed my baby?
HIV is present in breast milk, and researchers estimate a 29% HIV
transmission rate from HIV-positive mothers who consistently breastfeed
their children. The most recent information suggests that the risk
of HIV transmission from breastfeeding is highest in the early months
after birth. The US Public Health Service recommends that HIV-positive
women do not breastfeed their children and recommend formula feeding.
For several reasons, formula feeding may not be an option for some
women. In this situation, there are alternatives such as heat treatment
of breast milk, breast milk banks, or using animal milk such as
cow, goat or sheep. If formula feeding isn’t an option for
you, talk with a counselor, healthcare worker or nurse. They can
provide information on various infant-feeding options, the risks
and benefits, and guidance on selecting the best option for you
and your baby. See the Resource List for information on milk banks
in the U.S.
Can I take anti-HIV medicines while I’m pregnant?
Pregnant women who are HIV-positive will follow the same general
guidelines for taking anti-HIV therapy as “non-pregnant”
adults. Depending on a woman’s HIV disease status (her viral
load and CD4+ cell count), a doctor may or may not recommend starting
or continuing anti-HIV therapy (typically at least three drugs).
However, certain anti-HIV drugs can harm the developing baby, so
they are not recommended for use during pregnancy. See Medications
and Procedures to Consider.
AZT (zidovudine, Zerit) has been studied widely in pregnant women
and is the only FDA-approved drug to use in reducing the risk of
transmission from mother to child. ACTG 076 was the famous study
which showed that AZT could protect a baby from getting HIV. During
the study, mothers took AZT before and during labor and the babies
were given the liquid form of AZT daily for six weeks after birth.
The risk of transmission was reduced from 25% to 8%. With the development
and use of anti-HIV therapy, transmission rates have been reduced
to less than 1%. If you decide to use anti-HIV therapy, your regimen
will most likely include AZT.
Nevirapine (Viramune) has also been shown to reduce mother-to-child
transmission, but it is not FDA-approved for use to reduce the risk
of mother-to-child transmission. Studies have included a single
dose of nevirapine given to the mother when she goes into labor.
The baby is given a single dose based on weight soon after birth.
There are concerns about using nevirapine that you should discuss
with your doctor before using it. See the box Nevirapine Warning.
How is HIV passed to the baby?
HIV can only be passed from mother to child if the mother is HIV-positive.
If the father is HIV-positive and the mother is not, a baby cannot
get HIV from its father. If a woman is HIV-positive, transmission
can occur at three points:
- while the baby is in the uterus (intrauterine);
- during labor and delivery (when the baby is being born);
or
- during breastfeeding (HIV is found in breast milk).
The most common routes of transmission are during labor and delivery
and during breastfeeding. There are several factors that can impact
the risk of transmission.
Factors that can impact the risk of transmission:
Viral load
Probably the strongest factor that can affect transmission is the
mother’s viral load. Viral load is the amount of HIV found
in about a teaspoon of blood. A viral load test will be done when
you’re first diagnosed with HIV and at least every three months
after that. Women with more advanced HIV, high viral load and/or
low CD4+ cell counts are more likely to pass HIV to their babies.
The goal of HIV treatment is to reduce viral load to as low as possible,
preferably to undetectable levels or below 50 copies/ml. If a mother’s
viral load is undetectable when she goes into labor, the risk of
transmission is almost zero.
Time of ruptured membranes
The time between when the water breaks and the actual delivery is
called “duration of ruptured membranes.” The longer
this time is the greater the risk of passing HIV. Most doctors will
try to keep this time period to less than four hours. Research shows
that if it goes over four hours, then the baby is exposed to HIV
longer and there’s a greater likelihood of transmission. Induced
rupturing of the water bag (also called induced labor) should be
avoided whenever possible.
Overall health of the mother
Regardless of a woman’s HIV status, her overall health is
important for a healthy pregnancy and delivery. This includes proper
nutrition; getting enough exercise and rest; quitting smoking; avoiding
caffeine, street drugs and alcohol; and getting prenatal care. In
addition, many of these negative factors, such as smoking while
pregnant, can lead to premature birth or low birth weight. We know
from research that in both situations the baby is more at risk for
HIV infection. Therefore, it is important for the mother to take
care of herself, as her baby’s health is dependent on her
health.
Co-infections
It is important that you’re screened and treated early on
in your pregnancy for any sexually transmitted diseases (STDs) or
opportunistic infections (OIs). Having another infection—such
as hepatitis C, herpes or other STD—may increase the risk
of passing HIV to your baby.
Women who are co-infected with hepatitis C are twice
as likely to pass HIV to their infants. Many women living with HIV
are also living with genital herpes. It is common for women to have
a herpes outbreak during delivery. This can increase the risk of
HIV transmission as the sores have high levels of HIV. In addition,
there is a risk of passing herpes to the infant. If a woman has
a severe HIV-related OI, such as tuberculosis
or Pneumocystis jiroveci pneumonia
(PCP), there’s also a risk of increased HIV transmission.
Access to prenatal care with an HIV specialist
Prenatal care is the healthcare that a woman receives during her
pregnancy, before the baby’s birth. It includes:
- education and counseling on managing pregnancy;
- tests necessary to track the mother’s and
baby’s health;
- nutrition and exercise to maintain good health and
to gain enough weight to provide nourishment to both mother and
baby; and
- meetings with doctors: obstetricians (OB), gynecologists
(GYN), and perinatologists—those who specialize in the study
of the life and development of the baby during pregnancy.
Prenatal care should start as soon as your pregnancy
is suspected. However, it is also never too late to seek out and
begin prenatal care. The baby’s major organs develop during
the first trimester of pregnancy (first 14 weeks). Prenatal care
is critical during this time to check on the health of the developing
baby and identify development problems early on. After the first
visit, prenatal appointments usually continue monthly until the
beginning of the eighth month. At the eighth month, visits every
two weeks is usual; and at month nine, visits become weekly.
For women living with HIV, prenatal care is one
of the most important steps to a healthy pregnancy and safe delivery.
It is also wise to have your primary HIV doctor involved in your
care. Ideally, your primary HIV doctor has experience working with
pregnant women and women considering pregnancy.
This is also a time to talk with your primary HIV
doctor about your HIV health and any concerns you may have with
your anti-HIV regimen, side effects, etc. It’s also a good
time to consult with your pharmacist and prenatal team about the
impact of medications on your developing baby. Ideally, you will
want to have your primary HIV doctor, prenatal team and any other
social support—like a peer advocate—communicating and
working together for the health of you and your baby.
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