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Pregnancy

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• HIV/AIDS Drugs and Pregnancy
• Take These Steps to Lower the Risk of Giving HIV to Your Baby
• Paying for Care While You're Pregnant
• A Short Story: Maria and Enrique have a healthy baby
• Additional Resources

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 choices to make about lowering the risk of passing HIV to your baby.

If you want to become pregnant, the best first step you can take is to talk with your doctor. Your doctor can tell you how HIV or other health conditions and risk factors you might have could affect your or your unborn baby’s health. Your doctor can tell you what you can do now to be sure your pregnancy is planned and to help prepare your body for a healthy pregnancy. If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor’s help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps before and during your pregnancy to help you and your baby stay healthy:

• Take 400 micrograms (400 mcg or 0.4 mg) of folic acid every day for at least three months before getting pregnant to lower your risk of some birth defects of the brain and spine, including spina bifida.
• 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 immunizations if you need them to prevent opportunistic infections (OIs) like the flu or pneumonia.
• Stop smoking and drinking alcohol.
• Eat healthy foods.
• Get plenty of rest.

HIV/AIDS Drugs and Pregnancy

Pregnant women should take HIV medicines to lower the risk of passing HIV to their babies, and in some cases, for their own health. Treatment plans should include AZT/ZDV (zidovudine or Retrovir) when possible to lower the risk of passing HIV to your baby.

If you haven't used any HIV drugs before pregnancy and are in your first trimester, you may want to wait until after the first trimester 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, many vital organs and systems are formed during the first trimester, and we don’t know the effects some drugs have on a developing baby. Generally, women who need treatment should not wait to start, however. 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 sticking with your current treatment plan. Weighing the known and potential benefits and risks will help you decide whether to continue or stop HIV treatment in the first trimester. Unfortunately, researchers don't know if stopping your HIV drugs causes problems with your baby. Stopping HIV drugs could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could progress and cause problems for your baby. For these reasons, many doctors think stopping HIV drugs is not a good idea. On the other hand, the effects of some HIV drugs on an unborn baby are not yet known, so it's a big decision. If you decide to stop, 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 including AZT/ZDV in your treatment plan.

If you are already taking HIV drugs and find out you're pregnant after the first trimester, continue with treatment. Ask your doctor about including AZT/ZDV in your treatment plan.

During your pregnancy, your doctor may need to adjust your medicines. Changing your treatment will depend on many factors:

• Your CD4 count
• Risk of 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 available in the United States that should not be taken by pregnant women because they may cause birth defects or harm the mother:

• Delavirdine (Rescriptor)
• Efavirenz (Sustiva)
• Combination of stavudine (d4T or Zerit)/didanosine (ddI or Videx)
• Hydroxyurea (anticancer drug) during the first trimester

Short-term use of nevirapine (Viramune) can be part of a pregnant woman’s HIV treatment plan, but should be monitored closely. It should be used with caution in pregnant women who have never had HIV treatment and who have CD4 counts greater than 250.

Protease inhibitors (PIs) are associated with higher levels of blood sugar and diabetes. Pregnancy is also a risk for high blood sugar. But we don’t know if PI use increases the risk of pregnancy-related diabetes.

Use of nucleoside reverse transcriptase inhibitors (NRTIs) can lead to a buildup of lactic acid in the blood, which can cause problems for pregnant women and developing babies. So, doctors need to monitor pregnant women using NRTIs. There is also some concern whether tenofovir and abacavir could affect bone health of the unborn baby.

For some HIV drugs, we don’t know enough about them to recommend use during pregnancy. These include entry inhibitors and integrase inhibitors.

No one can tell you for sure if your baby will be born with HIV. You can help lower your baby's HIV risk and keep yourself healthy by getting regular prenatal care and closely following your HIV drug treatment plan. See the Treatment section for more information on HIV medicines.

Take These Steps to Lower the Risk of 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 lower the risk of 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 help you to have a healthy pregnancy.
• 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 your water break around your baby. Your doctor may recommend this type of delivery if your viral load is unknown or high; if you have not taken any HIV drugs or only AZT during your pregnancy; or if you have not had prenatal care. If your viral load is low and you have had prenatal care, your doctor may recommend 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.

Make sure your baby is tested for HIV right after birth. If your baby is HIV-positive, ask your doctor about starting your baby’s treatment right away. A new study showed that HIV-positive infants were four times less likely to die if given treatment immediately after diagnosis. Learn more about parenting a child with HIV.

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 one year after you deliver your baby. But this 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.

A Short Story: Maria and Enrique Have a Healthy Baby

Maria and her husband, Enrique, have been married for 5 years. This year, when Maria got the great news she was pregnant, she also found out she has HIV. This short story tells how one couple took steps to lower the risk their baby would be born with HIV.

Pregnancy was reviewed by:

Lisa Hirschhorn, MD, MPH
Senior Clinical Advisor, HIV/AIDS
JSI Research and Training

Additional Resources:

Publications

1.     Delivery Options for HIV Positive Pregnant Women — This publication discusses delivery options for pregnant women with HIV and what they can do to lower the risk of passing HIV to their babies during delivery.

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

2.     HIV and Pregnancy — This publication for women with HIV gives information on when to start HIV treatment during pregnancy, what medications are safe and unsafe to use during pregnancy, and how treatment can lower a woman’s risk of passing HIV to her baby.

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

3.     HIV During Pregnancy, Labor and Delivery, and After Birth — This series of fact sheets explains how a mother who has HIV can lower the risk of passing the virus to her baby during and after pregnancy.

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

4.   HIV Infection in Infants and Children — This publication gives 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 children and adolescents with HIV/AIDS, and AIDS-related psychosocial issues.

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

5.     HIV Testing and Pregnancy — This publication provides information on HIV testing during pregnancy, the benefits of being tested, and where to go to learn about HIV testing policies in your state.

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

6.   Mother-to-Child (Perinatal) HIV Transmission and Prevention — This fact sheet discusses the incidence of mother-to-child HIV transmission during pregnancy, labor and delivery, and breastfeeding. It also discusses how mothers that are infected with HIV can lower the risk of perinatal transmission and barriers to prevention efforts.

   http://www.cdc.gov/hiv/topics/perinatal/resources/factsheets/perinatal.htm

7. Children and HIV/AIDS: Providing Paediatric Treatment (Copyright © UNICEF) — This publication discusses the issues with providing pediatric care to children with HIV/AIDS globally and how the UNICEF is helping with this issue.

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

8. HIV/AIDS (Copyright © MOD) — This public education fact sheet explains why pregnant women should be tested for HIV.

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

9. Infant Feeding and HIV (Copyright © UNICEF) — This easy-to-read publication outlines the risks and benefits of breastfeeding for mothers with HIV. It provides advice on getting tested for HIV and ways a woman with HIV can provide the nutrition her baby needs instead of breastfeeding.

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

10. Standby Guardianship (Copyright © Family Ties Project) — Standby guardianship allows the custodial parent to make future plans for his or her children without having to legally transfer decision-making power. 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

11. Women, Children, and HIV (Copyright © UCSF, UMDNJ) — This web site provides resources on the prevention and treatment of HIV infection in women and children for health workers, program managers, and policy makers in resource-limited settings.

    http://www.womenchildrenhiv.org/

Organizations

1.   Administration for Children and Families
2.   AIDSinfo
3.   Centers for Disease Control and Prevention, HHS
4. AIDS InfoNet
5. Center for AIDS Prevention Studies, ARI, UCSF
6. Family Ties Project
7. March of Dimes Foundation

= Indicates Federal Resources

Content last updated March 4, 2009.