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Guide to HIV, Pregnancy and Women's Health: HIV Drugs and the Baby's Health

By Polly Clayden

March 2013

In the past particularly, some mothers and doctors have been reluctant to use or to prescribe antiretrovirals during pregnancy. This is out of concern for unknown effects to the baby.

It is difficult to know if there are any long-term effects.

Careful follow-up of children exposed to AZT has not shown any differences compared with other children.

All children born to HIV positive women in the UK (and many other countries) are also being monitored. This close monitoring will provide important safety information in the future.

Ultimately, it seems clear that the biggest risk to a baby born to a mother with HIV is HIV itself. Antiretrovirals can prevent this.


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Will Antiretrovirals Affect the Baby?

These concerns are justifiable. Unfortunately there are no definite answers, but the available evidence so far shows that the drugs appear to be safe.

Some reports have looked at the risk of prematurity, birth defects and toxicity in babies.


Prematurity

Several studies show a greater risk of prematurity (baby born at less than 37 weeks) and low birth weight for babies born to mothers taking ART with three or more drugs and particularly with PIs.

A British study found an overall rate of 13 percent (normally the rate here is about 6 to 8 percent).

This should not be a reason for a mother to avoid treatment in pregnancy, particularly if she needs it for her own health. It is important to be aware of the risks and options though, discuss them with your healthcare team and make sure that you are receiving the best possible treatment, care and monitoring for yourself and your baby in your situation.


Can Antiretrovirals Cause Birth Defects?

There have been very few reports of birth defects in babies whose mothers have taken these drugs in pregnancy. The only caution at the moment is possibly with the two drugs ddI and nelfinavir, neither of which is recommended in the UK.


What About Anaemia?

Anaemia has been seen in babies born to mothers on antiretrovirals but this passes quickly and rarely requires a transfusion.


What About Bilirubin?

The levels of bilirubin in the baby may also be higher than normal with atazanavir and your healthcare team will follow your baby's bilirubin levels very carefully and may give the baby phototherapy to reduce the levels of bilirubin.

Although extremely high levels of bilirubin may damage a baby's developing brain there have not been any reports of this occurring with atazanavir.


Will My Baby Be Monitored for These Symptoms?

Yes. Babies born to HIV positive mothers on treatment will be monitored very carefully.


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