HIV and Pregnancy -- Keeping Yourself and Your Baby Healthy
Lowering the Risk During Labor and Delivery
Again, the goal is to limit the baby's exposure to the virus. So it's probably not surprising that your options for labor and delivery depend upon your viral load (another important reason to take your HIV meds as prescribed). The American College of Obstetricians and Gynecologists (ACOG) has recommended considering a scheduled C-section delivery for HIV-positive women since 1999. A scheduled C-section is recommended for women with a viral load that's greater than 1,000 copies/mL near the time of delivery (36 weeks' gestation) and for any woman with an unknown viral load. It is also recommended for women who did not receive HIV medication during pregnancy. In these situations, ACOG recommends a scheduled C-section at 38 weeks' gestation in order to decrease the likelihood of onset of labor or rupture of membranes before delivery.
For women with a viral load that's less than 1,000 copies/mL near time of delivery, a scheduled C-section is not routinely recommended. So, if your viral load is less than 1,000 copies/mL near the time of delivery, your choices for labor and delivery are essentially the same as a woman who doesn't have the virus, and you can have a vaginal delivery. The risk of perinatal transmission of HIV in women with an undetectable viral load (at 36 weeks gestation) is 1% or less, even with a vaginal delivery. No evidence is available to show that this risk can be lowered further by performing a scheduled C-section. Remember, a C-section is major surgery and has its own risk of complications, compared with vaginal delivery.
Under new DHHS guidelines, only women with viral loads of more than 400 copies/mL should be given IV zidovudine (AZT) continuously, even if your genotype shows resistance for this drug. The use of AZT is recommended because of its unique characteristics and its proven record in reducing transmission.
To help prevent transmission, your baby will be given liquid AZT immediately after birth and this will be continued (by you at home) twice a day for six weeks.
Unfortunately, women in the U.S. with HIV should not breastfeed their babies due to increased risk of transmitting the virus. Baby formula is a safe and healthy alternative to breast milk and there are many brands and options that are available to you. Also, while the risk is very low, HIV can also be transmitted to a baby through food that was pre-chewed by an HIV-positive mother (or caretaker). To be completely safe, babies should not be fed pre-chewed food.
Does the Baby Have HIV?
There are two types of tests that will be performed on your baby to find out if he or she has HIV. The first is the HIV antibody test. All babies born to a mom with HIV will test positive for the first several months of their lives. This does not mean that they have HIV. Rather, it means that the baby has simply been exposed to his/her mother's HIV. The second test, PCR testing, looks for the virus and not just the antibodies to the virus. It is this test that can tell whether the baby has HIV or not. This test will be done during the first few days of his/her life.
The PCR test will be repeated several times on your baby. To know for certain that your baby is not infected with HIV, the baby must not be breastfeeding and must have two negative PCR tests, the first at one month (or older) and the second at four months (or older). Many experts confirm the HIV-negative status of the baby with an HIV antibody test at age 12 to 18 months. To be diagnosed with HIV, a baby must have two positive PCR tests.
Again, just because you have HIV does not mean you can't have a healthy pregnancy and baby. In fact, just this past year I had an HIV-positive patient who followed her regimen and had a healthy pregnancy, and an uncomplicated vaginal birth. She and her husband welcomed a healthy HIV-negative baby into the world. It can be done, and it is done by lots of women just like you every day. So, again, congratulations!
John Verna has spent his entire professional career providing health care to individuals with HIV. For the past three years, he has worked at Access Community Health Network in Chicago. John knows just how special (and scary) pregnancy can be, as he and his wife recently welcomed their first child.
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