Pregnancy and HIV
April 24, 2015
Table of Contents
- The Good News
- Before You Get Pregnant
- The Pregnancy Guidelines
- HIV Drugs and Pregnancy
- Tests, Procedures and Delivery
- After the Baby Is Born
- In Conclusion
Due to advances in HIV care and treatment, many women living with HIV (HIV+) are living longer, healthier lives. As women living with HIV think about their futures, some are deciding to have the babies they always wanted.
The good news is that advances in HIV treatment have also greatly lowered the chances that a mother will pass HIV on to her baby (also known as perinatal or "mother-to-child" HIV transmission). The World Health Organization reports HIV that can be perinatally transmitted as much as 45 percent of the time when mothers are not taking HIV drugs. However, with HIV treatment, the chances of perinatal transmission can be less than five in 100 births. According to the US Centers for Disease Control and Prevention (CDC), if the mother takes HIV drugs and is virally suppressed, the chances of transmission can be less than one in 100. It is also important to note that studies have shown that being pregnant will not make HIV progress faster in the mother.
One way we learn about how HIV drugs affect pregnancy is through the Antiretroviral Pregnancy Registry. Pregnant women living with HIV are encouraged to register (through their health care providers) with the Antiretroviral Pregnancy Registry at www.APRegistry.com.
It is important to plan carefully before getting pregnant:
- Discuss your plans with your HIV health care provider to make sure you are on the right treatment plan for your own health and to reduce the risk of perinatal (mother-to-child) transmission (more about this in the next sections)
- Find an obstetrician (OB) or midwife who is familiar with HIV care. He or she can explain your options for getting pregnant with as little risk to your partner as possible.
- Ask your HIV health care provider and your OB or midwife to talk with each other and coordinate your care before and during your pregnancy
- Get screened for sexually transmitted diseases (STDs), hepatitis C, and tuberculosis
- Do your best to give up smoking, drinking, and drugs -- all of these can be bad for your health and the health of your baby.
- Start taking pregnancy vitamins ("prenatal" vitamins) that contain folic acid while you are trying to become pregnant. This can reduce the rates of some birth defects.
- If friends and family do not support your decision to have a child, put together a support network of people who are caring, non-judgmental, and well educated about HIV and pregnancy. Your network can include medical providers, counselors, and other women living with HIV who are considering pregnancy or who have had children.
If you are a woman or man living with HIV who is looking for more information on getting pregnant or having a child, please go to: Getting Pregnant and HIV.
Several groups of experts on pregnancy in women living with HIV have developed guidelines that provide information about appropriate care and treatment for HIV+ women who are, or may become, pregnant.
As a first step, the pregnancy guidelines issued by the US Department of Health and Human Services (DHHS) recommend a thorough check up, including a number of blood tests, to find out about your health and the status of your HIV infection. A resistance test (see The Well Project's article on resistance for info about this test) should be included if you:
- Are starting HIV drugs
- Are taking HIV drugs and have a detectable viral load (500 - 1,000 copies or more)
The results of a resistance test can help you and your health care provider choose the best drugs to take.
HIV drugs can reduce the risk of perinatal transmission. For this reason, HIV drugs are recommended for all pregnant women regardless of CD4 count and viral load. Even if the mother does not need HIV treatment for her own health, it is important for her to take HIV drugs to lower the risk of perinatal transmission. The drugs need to be taken just as they are prescribed to have the best chance of working (see The Well Project's article on adherence for more info). Also, if a woman living with HIV takes HIV drugs and gets her viral load very low, she reduces the chances of spreading HIV to her sexual partners.
The World Health Organization (WHO) also recommends lifelong HIV drugs (antiretroviral therapy, or ART) for all pregnant and breastfeeding women living with HIV regardless of CD4 count ('option B+'). For countries where option B+ is not available, the WHO recommends that HIV+ pregnant and breastfeeding women with CD4 counts under 500 receive lifelong HIV drugs. For HIV+ pregnant and breastfeeding women with CD4 counts over 500, it recommends that women living with HIV start to take HIV drugs during pregnancy and stop taking them after the completion of breastfeeding.
The British HIV Association suggests that all pregnant women living with HIV take HIV drugs to prevent passing HIV to their unborn babies. Moreover, women who begin taking HIV drugs while they are pregnant to prevent perinatal transmission (and not for their health; those with CD4 counts > 350) can stop taking antiretroviral therapy after their babies are born. The US guidelines recommend that you continue taking antiretroviral therapy regardless of your CD4 count.
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