Pregnancy and HIV
April 24, 2015
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.
The DHHS recommends that women have their CD4 counts checked every three months during pregnancy. However, women whose viral loads remain consistently low can get their CD4 counts checked every six months during pregnancy.
There are 2 types of delivery, cesarean (C-section) and vaginal delivery:
Elective or planned C-sections are 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. C-sections are recommended for pregnant women living with HIV who:
- Have an unknown viral load
- Have a viral load greater than 1,000 copies at 36 weeks of pregnancy
For a woman on combination HIV treatment with a low viral load (less than 1,000), a C-section is not likely to further reduce her already 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.
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 also need to take medication to prevent pneumonia after finishing Retrovir, unless there is adequate information to confirm that the infant does not have HIV. Taking these medications does not mean the baby is sick; it is just a precaution to decrease the chances of getting HIV and other illnesses.
The baby will receive several HIV tests to determine if he or she is infected. An HIV polymerase chain reaction (PCR) test should be used. These tests look for the HIV 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 12 to 18 months.
HIV virus testing should be done when the baby is 14 to 21 days old, one to two months old, and four to six months old. A positive HIV virus test should be confirmed with a second test. Two positive HIV virus tests mean that the baby has HIV infection. If the baby has two or more negative tests with one at one month and another at four months or later, when the mother is not breastfeeding, then she or he does not have HIV infection. Many experts confirm that the baby does not have HIV by doing an HIV antibody test when the baby is 12 to 18 months old.
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 HIV virus. While it is still possible to transmit HIV through breastfeeding, the chances are less than originally thought.
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 by someone who is HIV+ (pre-masticated). This can spread HIV to your child.
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 (OB) 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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