À la Carte -- 7. Pregnancy and Breastfeeding

Pregnancy

If you are pregnant, good nutrition can help you have a healthier newborn. This is especially important if you are HIV positive because pregnant women with HIV are at higher risk of giving birth before they are due and having a newborn that is underweight.

Pregnant women with HIV, like all pregnant women, need more calories, protein and micronutrients, especially folic acid and iron. But it is sometimes hard to meet those needs, especially if you're HIV positive; morning sickness and side effects of HAART may make it hard to eat enough or to keep food down.

Taking HAART while you are pregnant greatly reduces the risk of infecting your baby. Women taking HAART may be at higher risk of developing gestational diabetes, a type of diabetes that occurs only during pregnancy. Talk to your healthcare team about this. Dietary strategies may help decrease this risk.

Recommendations for Pregnancy

• Get good prenatal care. Try to find a doctor who has experience with pregnant women with HIV.
• If considering pregnancy, take 1 mg folic acid daily and eat plenty of fruits and leafy green vegetables.
• When pregnant take a daily prenatal vitamin. Prenatal vitamins are different than regular vitamins in that they have higher amounts of folic acid and iron and lower amounts of vitamin A.
• In the first trimester, add 100 calories a day to your diet.
• In the second trimester, add another 200 calories to what you were eating during the first trimester. Also add 20 grams of protein.
• In the third trimester, add another 4 grams of protein a day.

Recommended Amounts of Weight Gain Depend on Pre-Pregnancy BMI

• If you are underweight (BMI less than 20), expect to gain 12.5 to 18 kg (27.5 to 39 lbs).
• If your weight is in the ideal range (BMI between 20 and 25), expect to gain 11.5 to 16 kg (25 to 35 lbs).
• If you are overweight (BMI more than 25), expect to gain 7 to 11.5 kg (15 to 25 lbs).

Dealing With the Discomforts of Pregnancy

• To deal with morning sickness or nausea from anti-HIV drugs:
  • Eat bland, low-fat foods. As well, salty foods, room-temperature foods and dry foods might also be easier to tolerate.
  • Eat every 2 to 3 hours to prevent low blood sugar.
  • Don't brush your teeth immediately after eating.
  • Ginger may be helpful (ginger ale, ginger tea or ginger supplements).
  • If iron supplements increase nausea, take the supplement with plenty of food.
  • Ask your doctor about Diclectin, an anti-nausea medicine that is safe to use during pregnancy and can be taken with HAART.
  • See "Nausea and vomiting," Chapter 6, for more ideas.
• For heartburn, eat small meals of foods that are not spicy or acidic. Avoid foods like black pepper, tomatoes, oranges and lemons.
• For constipation, increase fibre and fluids. Try high-fibre bran cereals once or twice a day (see "Constipation," Chapter 6).
• Limit your intake of juice, soft drinks and sugar. This will help your insulin work well and will minimize the chance of developing gestational diabetes.
• Keep active and get plenty of rest.
• Alcohol, street drugs and tobacco are all harmful to the developing infant. Stopping use or cutting down during pregnancy will increase your chances of having a healthy baby.

Breastfeeding

When an HIV-positive mother breastfeeds her baby, there is a risk of at least 16% that the baby will become HIV positive. In Canada, mothers with HIV are advised to completely avoid breastfeeding and to feed the baby commercial infant formula. Some provinces have subsidized formula programs that help pay for the formula. Ask your healthcare team about the programs in your province.