Pregnancy and HIV
Table of Contents
- The Good News
- Before You Get Pregnant
- The Pregnancy Guidelines
- HIV Drugs and Pregnancy
- Invasive 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 HIV+ women 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 (known as the rate of mother-to-child HIV transmission). If the mother takes appropriate medical precautions, the chances of transmission can go down from about one in four (when not taking any HIV drugs) to less than one in 50 (when taking proper HIV drugs). In addition, 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. HIV+ pregnant women 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 transmitting HIV to your baby (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 to make sure you receive appropriate care before and during your pregnancy
- Get screened for sexually transmitted diseases (STDs), hepatitis B and 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 HIV+ women who are considering pregnancy or have had children.
If you are an HIV+ woman or HIV+ man looking for more information on getting pregnant or having a child, please click the link below:
A group of experts on pregnancy in HIV+ women has 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 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 TWP sheet 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
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 transmitting HIV from mother to baby. 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 mother-to-child transmission. The drugs need to be taken just as they are prescribed to have the best chance of working. (See TWP sheet on adherence for more info.) Also, if an HIV+ woman takes HIV drugs and gets her viral load very low, she reduces the chances of spreading HIV to her sexual partner.
There are certain HIV drugs that should be avoided or used with caution because of possible side effects in the mother or the developing baby. Some examples are Sustiva (efavirenz), Atripla (which contains Sustiva), and the combinations of Videx (didanosine, ddI) and Zerit (stavudine, d4T) or the combination of Zerit and Retrovir (zidovudine or AZT). Viramune (nevirapine) should not be started in HIV+ women with CD4 cell counts over 250.
Discuss the risks and benefits of the HIV drugs with your health care provider so that you can decide which treatments are best for you and your baby. Your health care provider can call the National Perinatal HIV Hotline at 1-888-448-8765 for free, expert advice on all aspects of caring for HIV+ pregnant women.
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