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HIV/AIDS Resource Center for Women
Michelle Lopez Alora Gale Precious Jackson Nina Martinez Gracia Violeta Ross Quiroga Loreen Willenberg  
Michelle Alora Precious Nina Gracia Loreen  
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Pregnancy and HIV

March 1, 2017

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Tests, Procedures and Delivery

There are a number of invasive prenatal tests, such as amniocentesis, chorionic villus sampling (CVS), and umbilical blood sampling that may increase the risk of HIV transmission to the baby. Talk to your health care provider if you need these tests. Certain procedures during delivery, such as invasive monitoring and forceps- or vacuum-assisted delivery, should be avoided if possible.

Viral loads should be checked when first coming into prenatal care, when first starting HIV drugs, and every month thereafter until the mother's viral load is undetectable. At that point, viral loads can be checked every trimester (every 12 weeks) during pregnancy. The viral load should be checked at 36 weeks of pregnancy before going into labor to determine the type of delivery that is best for the mother and baby.

There are 2 types of delivery: cesarean (C-section) and vaginal delivery.


C-Section

Women living with HIV do not need, and are not recomended, to have a C-section unless they:

  • have a viral load of more than 1,000 copies
  • have an unknown viral load, or
  • need a C-section for pregnancy-related reasons other than preventing HIV transmission.

If a woman needs an elective (or planned) C-section, it is done before labor begins and before the mother's "water" (sac of fluid that surrounds the baby) breaks. This reduces the baby's contact with the mother's blood and may reduce the risk of transmission in certain cases. Since C-sections require surgery, they carry some risks. Women who have C-sections are more likely to get infections than those who give birth vaginally.


Vaginal Delivery

For a woman on combination HIV treatment with a low viral load (less than 1,000), a C-section has not been shown to further reduce her already very low risk of transmitting HIV.

The decision of which type of delivery is best for you should be discussed with your health care provider early in your pregnancy.


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After the Baby Is Born

During the first four to six weeks, the baby will need to take Retrovir (and possibly other HIV drugs). A blood test called a complete blood count (CBC) should be performed on the newborn baby as a baseline.

The baby will receive a test for HIV viral load to determine if he or she has acquired HIV. This test looks for the virus, rather than HIV antibodies. HIV antibody tests, which are commonly used to determine HIV infection in adults, should not be used in newborns since babies carry their mother's antibodies for up to 18 months.

HIV virus testing should be done when the baby is first born, at one month, and at four months. If the baby has two negative tests by four months, the baby does not have HIV. If the baby has a positive HIV test, then the baby has HIV and must start HIV treatment right away. Many experts do an HIV antibody test when the baby is 12 to 18 months old just to be sure the antibodies from the mother have cleared from the baby's immune system.

Since it is possible to transmit HIV through breast milk, in the US and other high-resource countries where water is safe and formula is available and affordable, it is strongly advised that you not breastfeed. You can still have a strong bond with your child even if you bottle feed.

If you live where safe water is not easy to get, the risk to your baby of life-threatening conditions from formula feeding with unsafe water may be higher than the risk of HIV infection through breastfeeding. In some areas, formula may also be too expensive or not regularly available. If you are in either of these situations, it is better to feed your baby on breast milk alone while continuing to take your HIV drugs.

The good news is that breast milk contains many important antibodies to keep your baby healthy and has been found to have a protein, Tenascin-C, that helps neutralize the virus. While it is still possible to transmit HIV through breastfeeding, the chances are less if you are on HIV drugs and your viral load is undetectable.

Mixed feeding, in which a baby is given breast milk as well as other liquids (e.g., formula, sugar water, gripe water), is not recommended. It is currently thought that mixed feeding may damage the lining of babies' stomachs and make them more likely to get HIV when exposed to it in breast milk. If, for whatever reason, you cannot feed your baby exclusively on formula, it is recommended that you take HIV drugs and feed with breast milk alone.

The WHO recommends that if you breastfeed, breast milk should be the only source of food for your baby for the first six months of life. Between months six and 12, it recommends that the baby be introduced slowly to other foods until it is weaned from breast milk at 12 months (assuming the baby is receiving proper nutrition from regular food at that point). While breastfeeding, it is important that the mother continue to take her HIV drugs to limit the chances of passing HIV to her baby.

It is also important not to feed your baby food that has been chewed first (pre-masticated) by someone who is living with HIV. Blood in the person's saliva can transmit HIV to your child.


In Conclusion

Deciding to have a baby is a big step for any woman, but for a woman living with HIV, it is even more complicated. Talk to your HIV health care provider and obstetrician or midwife before you start trying to get pregnant. If you plan ahead, there are many things you can do to protect your health and the health of your new baby.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
 

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See Also
Newly Diagnosed? Words of Encouragement from HIV-Positive Women
What Did You Expect While You Were Expecting?
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