HIV/AIDS and Pregnancy

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• HIV/AIDS Drugs and Pregnancy
• Take These Steps to Prevent Giving HIV to Your Baby
• Paying for Care While You're Pregnant
• Additional Information on HIV/AIDS and Pregnancy

Motherhood is a wonderful experience. Regardless of your HIV status, you are a woman first and may want to have children. Because HIV can be spread to your baby during the pregnancy, while giving birth, or by breastfeeding, you will have many issues to think about in order to have a healthy baby.

If you are pregnant or want to become pregnant, the best first step you can take is to talk with your doctor. You can decide together on the best treatment for you and your baby before, during, and after the pregnancy. Besides the normal measures you'll need to take before getting pregnant, there are other things you can do before you're pregnant to improve your health while you're pregnant:

• keep your viral load as low as possible by staying on the medicine your doctor has given you
• manage side effects from the HIV/AIDS drugs
• get shots if you need them to prevent opportunistic infections (OIs) like the flu or pneumonia
• keep a healthy diet
• get plenty of rest

HIV/AIDS Drugs and Pregnancy

Pregnant women who haven't used any HIV drugs before may want to think about waiting until after being 10-12 weeks pregnant to start any HIV treatment. Since you may have nausea and vomiting early in your pregnancy, it may be hard to start the HIV drugs. Also, because the effects of some drugs aren't known, your baby is more likely to be hurt by the drugs in the first trimester. Keep in mind that HIV is usually passed to a baby late in pregnancy or during delivery. Talk to your doctor about your health status and the benefits and risks of delaying treatment.

If you are already taking HIV drugs, and find out you're pregnant in the first trimester, talk to your doctor about the potential risks and known benefits to your baby if you continue drug treatment during your pregnancy. Decide if you want to stop taking the HIV drugs completely in the first trimester. If you do, all of the drugs should be stopped at the same time and then started again (later in the pregnancy) together at the same time. This will prevent drug resistance (drugs that don't work anymore). When you do start taking HIV drugs again during the pregnancy, talk to your doctor about choosing drugs that will reduce the chances of passing HIV to your baby, including ZDV/AZT (zidovudine). Unfortunately, researchers don't know if stopping your HIV drugs causes problems with your baby. If your viral load increases while you are off of your HIV drugs, your disease could progress and cause problems for your baby. Unfortunately, the effects of some HIV drugs on an unborn baby are not yet known, so it's a big decision.

If you are already taking HIV drugs, and find out you're pregnant after the first trimester, continue with treatment. Try to include ZDV/AZT in your treatment.

During your pregnancy, you may need to adjust your medicines while you're pregnant. Changing your treatment will depend on many factors:

• your CD4 count
• risk for disease progression
• use of HIV/AIDS drugs
• how far along the pregnancy is
• what is known and not know about the effects of the drugs on the fetus
• best treatment for the health of the HIV positive mother

There are certain drugs that should NOT be taken by pregnant women because they may cause birth defects:

• Hivid® (Zalcitabine)
• Rescriptor® (Delavirdine)
• Efavirenz (Sustiva®)
• D4T (Zerit®) for pregnant women who haven't used any HIV drugs before
• Combination of ddI and d4T (Videx® and Zerit®)
• Oral liquid of amprenavir (Agenerase®)
• Hydroxyurea (anticancer drug) during the first semester

Viramune® (Nevirapine) should be used with caution in pregnant women with HIV who have not yet started treatment and are being treated to prevent passing HIV to their babies.

No one can tell you for sure if your baby will be born with HIV. You can help protect your baby from HIV and keep yourself healthy by getting regular prenatal care and closely following your HIV drug treatment plan. It is important to learn more about having a healthy pregnancy.

Take These Steps to Prevent Giving HIV to Your Baby

Just because you have HIV doesn't mean your child will get HIV. In the United States, about 25 percent of pregnant HIV positive women who do not receive AZT or a combination of HIV drugs pass on the virus to their babies. If women do receive a combination of HIV drugs during pregnancy, the risk of giving HIV to the newborn is below 2 percent. The steps below can help prevent giving HIV to your baby.

• Get prenatal care. Going to your doctor before you get pregnant or as soon as you find out you're pregnant will improve your health and the health of your baby.

• Take HIV/AIDS medicines. Take HIV/AIDS drugs that include ZDV/AZT. Talk to your doctor about which HIV/AIDS drugs to take and when to take them.

• Lower the risk of passing HIV during delivery. Choose the type of delivery that will reduce the risks of passing HIV to your baby. A cesarean delivery or C-section is done so the baby doesn't touch the mother's blood. If you choose a C-section, you will deliver at 38 weeks to avoid labor and having the water break around your baby. Your doctor may recommend this type of delivery if you have a high viral load (higher than 1000 copies/mL at 36 weeks gestation) or if you're not taking HIV drugs. If your viral load is not detectable, you may want to consider a vaginal delivery since the risk of passing HIV to your baby this way is very low.

• Do not breastfeed. You can pass the virus to your baby through your breast milk.

Paying for Care While You're Pregnant

If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and HIV positive, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. You can stay on Medicaid for up to 90 days after you deliver your baby. It may continue for 1 year after you deliver your baby — that depends on the rules in your state. Each state makes its own Medicaid rules. If you don't think you qualify for Medicaid, check again. You may be able to get it while pregnant because the income limits are raised for pregnant women in all states to provide prenatal care and HIV treatment. To find out if you meet the requirements, contact your local or county medical assistance, welfare, or social services office. The number is listed in the blue pages of your telephone book. If you are unable to find that number, contact your state department of health.

Additional Information on HIV/AIDS and Pregnancy:

Publications

1.     HIV and Pregnancy - This publication for HIV positive women gives information on what medications are safe to take during pregnancy, and what the risk is that the baby will be HIV positive.

   http://aidsinfo.nih.gov/contentfiles/HIVandPregnancy_FS_en.pdf

2.   HIV during Pregnancy, Labor and Delivery, and After Birth - This series of fact sheets explains how a mother who has HIV can prevent transmission of the virus to her child pre-birth and post-birth. Advice is provided for all stages of pregnancy: during pregnancy, labor and delivery, and after birth.

   http://aidsinfo.nih.gov/ContentFiles/Perinatal_FS_en.pdf

3.   HIV Infection in Infants and Children - This publication contains information on the scope of the problem of HIV in children, transmission, prenatal HIV transmission, and diagnosis. Additional information is provided regarding the progression of the disease, signs and symptoms of pediatric HIV disease, treatment of HIV infected children, AIDS in adolescents, and AIDS-related psychosocial issues.

   http://www.niaid.nih.gov/factsheets/hivchildren.htm

4.     HIV Testing and Pregnancy - This publication provides information on being tested for HIV if you are pregnant and are looking for advice on mother-to-child transmission.

   http://www.aidsinfo.nih.gov/ContentFiles/HIVTestingandPregnancy_FS_en.pdf

5. HIV and AIDS in Pregnancy (Copyright © MOD) - This public education fact sheet explains why pregnant women should be tested for HIV and AIDS.

   http://www.marchofdimes.com/pnhec/188_705.asp

6. Infant Feeding and HIV (Copyright © UNICEF) - UNICEF provides an easy-to-read publication on the risks and benefits to breastfeeding for mothers with HIV. It provides advice on getting tested and provides various examples of infant nutrition to ensure you are making the right choice in this difficult decision.

   http://www.unicef.org/nutrition/23964_infantfeeding.html

7. Infant Formula (Copyright © AAFP) - If you are unable to breastfeed, this publication gives information on choosing and preparing infant formula. It provides information on bottle warming and also explains the different types of formula that you can purchase and how to prepare it.

   http://familydoctor.org/178.xml

8. Prevention of Parent-to-Child Transmission of HIV/AIDS (Copyright © UNICEF) - This publication provides statistics on the frequency of mother-to-child transmission of HIV and the clear difference of transmission rates between a parent taking preventative steps and one who neglects prevention.

   http://www.unicef.org/aids/index_preventionMTCT.html

9. Standby Guardianship (Copyright © Family Ties Project) - This web site provides detailed information on The Standby Guardianship Act of 2002 in the District of Columbia and information and resources on similar legislation in the other states.

   http://www.standbyguardianship.org

10. Women, Children, and HIV (Copyright © UCSF, UMDNJ) - The goals of this web site are to: disseminate state-of-the-art clinical information and training resources on mother-to-child transmission of HIV (MTCT) and related topics; communicate the best practices in preventing mother-to-child transmission of HIV (PMTCT) and caring for infected children; disseminate PMTCT program resource materials; disseminate state-of-the-art clinical information and training resources on perinatally acquired pediatric HIV infection; and implement services responsive to the needs of the CDC Global AIDS Program (CDC/GAP).

    http://www.womenchildrenhiv.org/

Organizations

1.   Administration for Children and Families
2.   AIDSInfo
3.   CDC-INFO
4.   Divisiones para la Prevención del VIH/SIDA, CDC
5. AIDS InfoNet
6. Center for AIDS Prevention Studies, ARI, UCSF
7. Family Ties Project
8. March of Dimes Birth Defects Foundation

= Indicates Federal Resources

Content last updated January 25, 2008.