Pregnancy and HIV disease

Issues that positive women may face when they're pregnant

August 2005 View PDF En español

A baby is on the way ...

Appropriate HIV care and treatment
Finding a healthcare team that supports your decisions and a personal support system to help you along the way are key to a healthy pregnancy and safe delivery for both you and your baby. This includes finding an obstetrician that has experience working with HIV-positive women considering pregnancy, getting regular and good prenatal care, monitoring and managing your HIV disease, and screening for and treating any STDs or OIs earlier rather than later in your pregnancy.

Making a decision about anti-HIV treatment
During the first trimester, if no urgent medical reason exists to begin anti-HIV therapy, it may be beneficial to delay therapy until after 12–14 weeks of pregnancy. There are two main reasons for waiting until the second trimester. First, “morning sickness” (nausea common in the first trimester) may make it difficult to keep medications down and can make adherence to regimens especially difficult. Waiting until the second trimester, when morning sickness usually subsides, may ease the difficulty of taking medicines.

Second, the effects of anti-HIV drugs on the baby during the first trimester are unknown. The baby completes the development of most of its organs at twelve weeks. So, many think it’s best to wait until organ development is complete before starting therapy. However, women who feel it’s important to start therapy earlier should follow their instincts and will not be denied therapy.

For women who already take therapy, stopping therapy during the first trimester to allow for organ development can cause the mother’s viral load to rebound, which may lead to increased transmission risk. On the other hand, continuing the regimen throughout the first trimester may negatively effect the baby’s development. The decision around starting or stopping will vary from person to person. Discuss what would be the best decision for you with your doctor.

If you stop anti-HIV therapy, discuss with your doctors how to do this safely. Regardless of your decision to use anti-HIV drugs during pregnancy, prenatal care and close monitoring of health and lab work (including CD4+ cell counts and viral load) is important.

Making a decision about delivery
Delivering your baby is a personal and emotional experience and can be very different for each woman. For women living with HIV, this is a very complicated issue. It is best to work with your doctor when considering which mode of delivery will help reduce the risk of transmission to your baby. There are two types of delivery: Caesarean section (C-section) and vaginal delivery.

C-section is a major operation that requires stitches after cutting through and separating the mother’s stomach muscles and uterus to deliver the baby. As with any major operation, a C-section—including elective ones—is not without risk. C-sections pose additional risks to mothers (such as post-surgery bleeding or infections). These risks should be weighed against the benefits of C-sections. Elective or scheduled C-sections are done before labor begins and before the mother’s “water” (the membrane that surrounds the baby) breaks. This reduces the baby’s contact with the mother’s blood. In general, a scheduled C-section may most benefit a woman who has a high viral load or who has an STD such as herpes or hepatitis C, as it will reduce the time of exposing HIV to the infant.

A vaginal delivery is the birth of the baby through the vagina. For women whose overall health is good and who have a low or undetectable viral load, a vaginal delivery is a viable option.

Either choice is a good choice, as long as it’s your own and you work with your doctor to decide which mode will ensure the safest delivery for you and your baby.

Nutrition and exercise
The baby’s health and nutrition is dependent on the mother’s health. Poor nutrition and insufficient weight gain in the mother can increase the risk of a premature or low birth weight baby, thus increasing the risk of passing HIV. Body and weight changes do occur during pregnancy, and it’s important the woman gains enough weight to provide nourishment for herself and her baby. While the average weight gain during pregnancy is 25–30 pounds, this will vary based on a woman’s build and her metabolism.

Positive women may have trouble gaining weight and may gain less than what is usually recommended during pregnancy. Common side effects from anti-HIV medication can make gaining weight difficult or even cause weight loss. At your first prenatal visit, a careful assessment of your nutritional needs will be done.

Pregnancy increases the need for calories and protein. Folic acid, iron, calcium and fluids are all important to the baby’s development. Proper levels of each should be included in the mother’s diet. Most women are recommended to take a folic acid supplement at least three months before getting pregnant or as soon as they find out that they are pregnant.

Regular exercise is important. It strengthens and tones muscles, making pregnancy, labor and delivery easier to experience. Swimming and walking are beneficial since they place little strain on muscles. Good rest is also necessary. Pregnant women should check themselves carefully and not overextend themselves. At least eight hours of sleep a night is recommended, and many women will find they need even more.

Learning if your baby is HIV-positive or -negative
It’s natural to want to know right away whether your baby is infected with HIV. Still, it often takes at least three months and as long as eighteen to definitively learn the HIV status of your baby. During this time, your baby will receive a number of blood tests.

All babies born to HIV-positive mothers, including babies who are not HIV-infected, will test positive for HIV antibodies at birth and for many months afterward. This is because a baby is born with its mother’s antibodies. It takes time for the baby to lose them and develop his or her own. Your baby will be tested for HIV at birth and then at one month and at three months.

If you’re not breastfeeding and all of these tests come back negative, your baby is not infected with HIV. After the baby is born, your doctor will likely advise that he or she take anti-HIV drugs for 4–6 weeks. This will most likely be AZT in liquid form taken two or four times a day. Studies suggest that this use of anti-HIV medicine for the first few weeks of life plays some role in further lowering the risk of HIV infection in your baby.

If the tests come back positive and your baby is determined to be infected with HIV, your doctor will discuss treatment and care options for your child. See the Resource List for organizations with information on pediatric HIV/AIDS.

Frequently asked questions

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