HIV / AIDS and Pregnancy

Pregnant WomanIf you have been diagnosed with HIV and want children in the near future, you probably are wondering if a successful pregnancy is even possible. It's true that having HIV while pregnant is considered a high-risk pregnancy, with the most important complication being the possibility of transferring the virus to your baby. That is no small risk. You know what it is like to live with HIV.

However, recent medical advancements in the treatment of HIV/AIDS provide for ways for a woman to significantly reduce the risk of her baby contracting the virus and successfully give birth to a healthy child. Still, mothers with HIV condition should understand the risks involved with HIV/AIDS before deciding to get pregnant. This type of pregnancy requires early medical intervention to create an appropriate treatment plan, and mothers will need to be committed to maintaining this treatment throughout gestation.

It is worth saying here that if you have AIDS, there are a lot of very powerful reasons not to get pregnant. We can debate HIV but if you have signs and symptoms of AIDS, our opinion is that it is unwise to get pregnant.

What is HIV/AIDS?

If you are reading this, you know exactly what HIV and AIDS are. The term HIV is short for Human Immunodeficiency Virus. This is a virus that can be spread through infected blood, semen, or vaginal fluids when they come into contact with broken skin or mucous membranes. HIV targets certain cells in the body called T-cells. T-cells are used to help the immune system fight off infections. Over a long period of time, HIV destroys the T-cells, therefore reducing a person's ability to fight off infections, certain cancers, and other health conditions. Once a person contracts HIV, the condition cannot be cured, but there are many medications that can help prevent the loss of T-cells and keep the immune system active.

If HIV is left untreated, the virus progresses into AIDS, which is short for Acquired Immunodeficiency Syndrome. AIDS is diagnosed once a person's T-cells levels drop below a certain amount (usually below 200). It can take a long time for HIV to progress into AIDS, sometimes taking up to 10 years or longer. When a person acquires AIDS, they no longer have the ability to fight off diseases and become much more susceptible to infections.

In the United States, there are an estimated 120,000 to 160,000 women who are infected with HIV. Out of that number, around 6,000 women with HIV give birth every year. Approximately 15,000 children have been infected with HIV since the beginning of the HIV/AIDS epidemic in the early 1980s, with 90% of those infections being transmitted during pregnancy or birth. 3,000 children with HIV have died from the virus. Transmitting HIV from mother to child during pregnancy, labor, delivery, or breastfeeding is referred to as perinatal transmission.

How Does HIV Affect my Baby?

Transmission of HIV to your baby during pregnancy means they will be born with the condition and will need long-term treatment, possibly for the rest of their life. Besides this important risk, HIV usually does not cause other complications. A mother can reduce her risk of transmitting the infection if she takes appropriate steps to stay as healthy as possible during pregnancy. The baby's placenta also provides a barrier that can help protect them from HIV. Most mothers will continue HIV treatment throughout her pregnancy, and thanks to the advancement of medication, the risk of a treated mother passing HIV to her baby can be as low as 1 percent. This is both a promising statistic and a daunting statistic all at the same time, right?.

There are certain factors that can increase the risk of transmission. Some of these can be prevented, but others may be out of your control. These factors include:

  • Smoking
  • Substance abuse
  • Vitamin A deficiency
  • Malnutrition
  • Infections such as STD's
  • The quantity of HIV virus in the blood
  • Factors related to labor and childbirth
  • Breastfeeding
Prenatal Care With HIV

Your initial prenatal visit may be more in-depth than usual so you and your doctor can establish what steps are necessary to have a healthy pregnancy. The two of you will discuss your medical history, any previous health conditions, and the current condition of your HIV/AIDS diagnosis. Your doctor will most likely focus on maintaining optimal health, often providing special counseling for a healthy diet to prevent malnutrition or vitamin deficiencies. It's also important that your doctor put certain measures in place to avoid sexually transmitted diseases, urinary tract infections, respiratory infections, and other conditions that could put your baby at a higher risk of contracting the virus.

As long as there are no complications, you may not need more prenatal visits than an average pregnancy would. Of course, both you and your doctor should carefully monitor your HIV symptoms and watch for any signs of possible infection.

Should I Take HIV Medication During Pregnancy?

You should absolutely take HIV medication while you're pregnant. HIV treatment during pregnancy drastically reduces the risk of your baby contracting the virus. Medication for HIV works by preventing the virus from multiplying, which keeps your viral load (the amount of HIV in the body) low. A low viral load not only keeps your baby safe but also helps you stay healthy by protecting your immune system. It's best to start HIV treatment as soon as possible. If you're considering getting pregnant, it's beneficial to start medication before you conceive. If you're already taking medication, you most likely will continue using it throughout pregnancy.

If you're wondering about whether HIV medication is safe for your baby, you can rest assured that most medications have been approved for usage during pregnancy. HIV medication is also not associated with an increased risk of birth defects. Still, when deciding which medication to take, doctors rely on different factors to determine what will be most effective. The doctor may take into account the woman's past history with HIV drugs, other medical conditions she may have, and whether or not she is resistant to certain medications. It's important that the chosen medication's benefits outweigh the risk of any kind of complication.

How Will HIV Affect Labor and Delivery?

Many women with HIV are able to have a successful delivery with no transmission of the virus. As previously mentioned, as long as you are taking treatment and staying healthy, the risk of transmission is extremely low. If a woman does not take any treatment, the risk of transmission during labor jumps to an estimated 25 percent. In those cases, it's recommended that doctors administer a combination of HIV drugs before she goes into labor. Taking HIV drugs for even a short amount of time before delivery can help reduce the risk of transmission.

There are certain things to avoid in labor for women with HIV. Doctors should generally not perform amniotomies (purposely rupturing the amniotic sac to artificially induce labor) or an episiotomy. Both of these procedures cause bleeding and increase the risk of transmission if the baby is exposed to it. In fact, the risk of transmission increases by 2% every hour after the membranes have been ruptured. If doctors are worried about the baby becoming infected, they might perform a scheduled C-section around 2 weeks before the expected due date.

Does my Baby Need HIV Treatment After Birth?

All babies with HIV positive mothers should be given HIV medication for the first few weeks of life to ensure they are protected from the virus. It's generally recommended that treatment continues for at least six weeks after birth. Some studies suggest that administering HIV drugs to both the mother and baby within 8-12 hours of birth can reduce the risk of transmission by 66%. HIV medications usually do not present any significant side-effects in babies besides some mild cases of anemia. HIV-negative babies who complete treatment will be able to continue developing normally.

Is it Safe to Breastfeed With HIV/AIDS?

It may not be safe to breastfeed if you have HIV/AIDS. It has been proven that the virus can spread into the breast milk and still infect your baby. The longer a baby is breastfed, the more likely the virus will be transmitted. Approximately 16% of babies who are breastfed by an HIV-positive mother will become infected if she is not using treatment. There are different factors that can influence the risk of transmission, such as the mother's breast health, the duration of breastfeeding, the mother's immune status, and whether or not she is breastfeeding exclusively. In general, however, the best way to prevent transmission is to not breastfeed at all and instead use formula substitutes for nutrition.

Outlook for HIV/AIDS Pregnancy

Having a diagnosis of HIV makes the decision to get pregnant and a tough one. There are options available to keep your baby as save as possible. But there is no denying there are real risks. We do not have the answer for you. We are just trying to give you the information to make the best call for you and any potential life you bring into this world.

The good news is the risk of transmission can be dramatically reduced. But an expecting mother with HIV will need to be committed to her treatment plan and work hard to stay as healthy as possible. Babies born from an HIV-positive mother should always be treated with medication even if there was a low risk of transmission. Thanks to all the advances doctors have made with HIV/AIDS treatment, women with this condition do not necessarily have to limit their opportunities in creating a family. What should you do? We do not know. The best path is to get educated and then talk to your doctor and your partner.

Sources and Additional Literature