I’m pregnant and I’ve just found out I’m HIV positive
If you’re pregnant and have just discovered that you are HIV positive don’t panic, because with medical help and advice the risk of your baby being HIV positive can be as low as 2%. With no medical help the risk of your baby being infected with HIV is between 25 – 45%.
HIV can be transmitted from mother to baby (mother-to-child/vertical transmission):
- during pregnancy
- during birth
- after birth, through breastfeeding
The most important things you can do to prevent your baby becoming HIV positive are:
- taking antiretroviral drugs during labour
- giving the baby a short course of antiretroviral drugs after birth
This will reduce the risk of your baby being HIV positive to 10 – 20%.
Depending on which country you live in other things you may be able to do are:
- take antiretroviral drugs during your pregnancy
- not breastfeed
This will reduce the risk to around 2%.1
Which antiretroviral drugs can I take?
There are different drug treatment regimens available to prevent your baby becoming HIV positive that you can take during pregnancy and delivery. The most important time for the mother to take antiretroviral drugs is during labour, and for the baby immediately after it is born.
The most effective regimen for preventing transmission of HIV from mother to baby (available in western countries) is taking AZT from 14 to 34 weeks of pregnancy to birth, intravenous AZT during labour and AZT for the baby for six weeks. Without breastfeeding, this can reduce the rate of transmission to around 2%.2
Other drug regimens include:
- AZT from 28 weeks of pregnancy, during labour and for 1 week for the baby. This can reduce the transmission rate to around 8% without breastfeeding.
- AZT and 3TC from 36 weeks, of the pregnancy, during labour and for 1 week for mother and baby after birth. The can reduce the transmission rate to around 10% if you don’t breastfeed.
If you don’t have access to drugs during pregnancy and before your delivery, taking a single dose of nevirapine during labour and giving the baby a single dose of nevirapine at birth will reduce the risk of around of transmission to around 10 - 20% without breastfeeding.
If they are available, you can also take drugs earlier during your pregnancy. Whether you take them depends on how far along in your pregnancy you are and how ill you are with HIV.3
See our Introduction to HIV/AIDS Treatment page for more information about antiretroviral drugs and our Mother to Child Transmission page for more information about nevirapine and pregnancy.
I’m HIV positive and already on antiretroviral drugs
Sometimes an HIV positive woman who is already on treatment will find out that she is pregnant. Advice should be obtained urgently from your doctor about what is best for you to do. It may be sensible for you to change the drugs that you are taking, as some drugs are more suitable during pregnancy than others. It is not a good idea to come off or change your therapy before seeing your doctor. If you stop treatment suddenly during pregnancy, your viral load may rebound, and there may be an increased risk of HIV transmission to the baby. If you are thinking of changing or stopping treatment, you must see your doctor.
Are antiretroviral drugs safe for my baby?
Probably. Some studies have shown evidence of an increased risk of a baby being premature or low birth weight due to the use of HIV drugs during pregnancy, particularly protease inhibitors. However this is controversial and there have been studies showing no evidence of this. 4
Is a caesarean section better than a natural birth?
A caesarean section is an operation used to deliver a baby through its mother’s abdominal wall. When a mother is HIV positive it is done to protect the baby from direct contact with her blood and other bodily fluids.
Recent research shows that having a caesarean isn’t a significant factor in preventing the transmission of HIV from mother to baby. So unless you are ill with HIV or have a detectable viral load it probably won’t be recommended by your health care provider. Having a caesarean section delivery may also not be possible in many countries.5
When shouldn’t I breastfeed?
HIV is found in breast milk. If you do breastfeed there is a 25-45% chance of passing HIV to your baby. Not breastfeeding lowers this to 15-25%. So, if you have access to safe breast milk substitutes (formula) you are advised to not breastfeed.
When should I breastfeed?
If you live in a country where safe water isn’t available, the risk of life-threatening conditions from formula feeding may be higher than the risk from breastfeeding. Formula can also be too expensive to use regularly in some countries. If you are this situation it is better to feed your baby breast milk alone.
Mixed feeding is when a baby is fed with breast milk and other liquids such as formula, glucose water, gripe water or traditional medicine. It is now known that there is a higher risk of a baby becoming HIV positive from mixed feeding than exclusive formula feeding alone or breastfeeding. Mixed feeding may damage the lining of the baby’s stomach and intestines making it easier for HIV in breast milk to infect the baby.
AVERT.org has more information about Mother to Child Transmission of HIV and Children, HIV & AIDS .
update by Jane Pennington
References
- Public Health Service Taskforce recommendations for the use of antiretroviral drugs in pregnant HIV-1 infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States, December 2004
- HIV and Infant Feeding: Guidelines for Decision-Makers – A guide for health care managers and supervisors, WHO 2003
- Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: WHO guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource- constrained settings, 2004
- Association between ARV therapy during pregnancy and prematurity/low birth weight, Beckman, K. et al, 2004
- Pregnancy and HIV, thewellproject.org, Shari Margolese, 2003
Last updated February 2, 2005
