HIV and Pregnancy: Advice for Those Who Want to Start a Family

Posted by Jodi McCaffrey on Nov 29, 2022 1:26:51 PM
7 minute read

Dec. 1 is World AIDS Day. Since 1988, the day has been an opportunity for education and remembrance. Unlike in the 1980s, people with HIV are living longer, healthier lives. And while you can pass HIV to your baby during pregnancy, there are many ways to lower that risk to nearly zero.

HIV, or human immunodeficiency virus, is the virus that causes acquired immunodeficiency syndrome (AIDS). HIV enters the bloodstream through body fluids such as blood or sperm. Once in the blood, the virus takes over and kills CD4 cells, essential components of your immune system. When these cells are destroyed, your body has trouble fighting off diseases and infections.

AIDS develops when the number of CD4 cells decreases below a certain level and your immune system can no longer defend the body against diseases like pneumonia, infections and certain types of cancer.

There is no vaccine to prevent HIV infection. HIV infection can be treated but not cured. Medications can help those with HIV infection stay healthy longer and can decrease the chance of passing the virus to others.

Should I Try to Get Pregnant if I’m HIV-positive or if My Partner Is?

If you are HIV-positive, tell your doctor that you want to get pregnant. He or she can help you:

  • Decide if you need to change your HIV treatments to lower your viral load
  • Get as healthy as possible before you get pregnant to improve your chances of a healthy pregnancy and baby
  • Get pregnant without passing HIV to your partner
  • Prevent passing the virus to your baby

“Caring for people with HIV during pregnancy requires coordination among many doctors, including those who specialize in infectious diseases and maternal-fetal medicine, including high-risk pregnancies,” said maternal-fetal medicine specialist C. Andrew Combs M.D., Ph.D., senior advisor on maternal-fetal medicine clinical quality for the Pediatrix Center for Research, Education, Quality and Safety.

Women have a higher risk of HIV infection during vaginal sex than men. If you don’t have HIV but your male partner does, there are steps you can take to reduce your risk of getting HIV while trying to get pregnant, but, unfortunately, the risk can’t be completely eliminated.

Talk to your doctor about HIV medicine called pre-exposure prophylaxis (PrEP), which can help protect you and your baby from HIV. PrEP is highly effective for preventing HIV when taken as prescribed. You also may want to consider donor sperm or assisted reproductive technology, such as sperm washing or in vitro fertilization, to get pregnant. However, these options can be expensive and may not be covered by your health insurance plan.

How Could My Baby Get HIV From Me?

Your viral load is the amount of HIV you have in your body. Having both a high viral load and a low number of CD4 cells increases your risk of passing HIV to your baby. It also increases your likelihood of becoming sick. However, you can still pass HIV to your baby even if your viral load is low. Here’s how:

  • During pregnancy, HIV can pass through the placenta and infect the baby.
  • During labor and delivery, your baby may be exposed to the virus from your blood and other body fluids. For example, the amniotic sac breaks (when your “water breaks”) when a woman goes into labor. Once this happens, the risk of passing HIV to your baby increases. In fact, most babies who get HIV become infected at the time of delivery, according to the American College of Obstetricians and Gynecologists (ACOG).
  • Breastfeeding can pass the virus to your baby.

What Can I Do to Lower the Risk of Passing HIV to My Baby?

Just because you have HIV doesn’t mean your child will get it, too. Before effective treatment was available in the United States, about 25% of pregnant mothers with HIV passed the virus to their babies, according to the U.S. Department of Health and Human Services’ Office on Women’s Health. Now, however, if you’re on HIV medication and have an undetectable viral load, your risk of passing HIV to your baby is less than 1%. Your doctor can help you choose the best treatment for you and your baby before, during and after pregnancy. You’ll need to work closely with your doctor throughout your pregnancy to monitor your and your baby’s health.

You and your obstetrician-gynecologist (OBGYN) should discuss things you can do to lower the risk of passing HIV to your baby. ACOG recommends:

  • Taking a combination of anti-HIV drugs (drug regimen) during your pregnancy.
  • Having your baby by C-section if lab tests show that your HIV viral load is high.
  • Taking anti-HIV drugs during labor and delivery as needed.
  • Giving anti-HIV drugs to your baby when he or she is born.
  • Not breastfeeding. You can pass the virus to your baby through your breast milk even if you are taking medication. The best way to avoid passing HIV to your baby is to feed him or her infant formula instead of breastfeeding.

Anti-HIV drugs decrease the amount of HIV in the body. Everyone with HIV should take HIV medications. If you have HIV and are thinking about getting pregnant, HIV medication will help keep you healthy while also lowering the chances of passing the virus to your baby when you become pregnant.

If you haven’t taken HIV medications before getting pregnant and are in your first trimester, your doctor can help you decide if you should start treatment. The nausea and vomiting that often accompanies pregnancy may make it difficult to take medication, and some medications can affect your baby, so you’ll want to weigh your options.

If you take HIV medications and find out you’re pregnant during the first trimester, ask your doctor if you should keep taking your current medications. Stopping HIV medication could cause your viral load to increase. If your viral load increases, the infection risk also increases. This could make you sick or cause problems for your baby. Your doctor may recommend different medication or a different dosage while you are pregnant or trying to get pregnant.

“The risk of mother-to-child transmission of HIV is lowest if appropriate antiviral medications are used throughout pregnancy to keep the viral load low, or, better still, undetectable,” Dr. Combs said.

What Will Happen After My Baby is Born?

Your baby will be tested for HIV right after birth. The test looks for the virus in the baby’s blood. If your baby is HIV-positive, the Office on Women’s Health recommends that you seek out a doctor or clinic experienced in caring for babies exposed to HIV. These providers can tell you what follow-up tests your baby needs and when, and if your baby should start treatment right away. According to research, giving a combination of HIV drugs to newborns is better at preventing HIV than just taking azidothymidine (AZT, an antiretroviral medicine) alone.

If you’re HIV-positive, be sure to let your doctor know you are pregnant or think you are pregnant as soon as possible. If you plan to become pregnant, talk to your doctor right away. Your doctor can talk with you about how having HIV during pregnancy can affect your and your unborn baby’s health. Your doctor can refer you to specialists who can help ensure you have a healthy pregnancy.

“Before getting pregnant, people living with HIV should be referred for a consultation with infectious disease and maternal-fetal medicine specialists to discuss the risks of pregnancy while HIV-positive and how to minimize those risks,” Dr. Combs explained. “It’s important to use effective birth control to avoid unplanned pregnancy until you are fully informed about the risks to your and your baby’s health.”

Visit our website to learn more about the Pediatrix network of medical providers, including OBGYN, maternal-fetal medicine and infectious disease specialists.

Topics: Education, Maternal-Fetal Medicine, Health Observances, Pediatric & Newborn Infectious Disease, Prenatal, High-Risk Obstetrics

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