HIV, AIDS, and Pregnancy

This information was taken from AIDSinfo a service of the U.S. Department of Health and Human Services.  This website offers information on HIV/AIDS treatment, prevention, and research.  It also has a number of informative pamphlets about HIV/AIDS and Pregnancy (the links are available at the bottom of the page).

An estimated 120,000 to 160,000 women in the United States are living with HIV, and unfortunately many do not know they are infected. Each year, about 6,000 to 7,000 of these women give birth. Approximately 15,000 children in the United States have contracted HIV, and about 3,000 have died. About 90 percent contracted the virus from their mothers during pregnancy or birth. This section only tackles a portion of the issues concerning pregnancy and HIV/AIDS.  For more information follow the links at the bottom of the page.

I Am HIV Positive and Pregnant. Should I Take Anti-HIV Medications?

You should take anti-HIV medications if:

  you are experiencing severe symptoms of HIV or have been diagnosed with AIDS
  your CD4 count is 200 cells/mm3 or less
 
  your viral load is greater than 1,000 copies/mL
  You should also take anti-HIV medications to prevent your baby from becoming infected with HIV. Specific treatment to prevent mother-to-child transmission of HIV is discussed below.


What Medications Should I Take if I Am Pregnant or Think I Might Become Pregnant?

If you are pregnant or may become pregnant, you should consider the risks and benefits of HIV treatment to both you and your child. Some medications (such as Sustiva) should be avoided because they may cause birth defects if taken early in pregnancy. The effects of other anti-HIV medications are not yet known. It is important for you to talk with your doctor before and during your pregnancy so that together you can decide on the best treatment for you and your baby.

To reduce the risk of passing HIV to your baby, your treatment regimen should include a three-part ZDV (also known as zidovudine, AZT, or retrovir) regimen.

I Am Already on an HIV Treatment Regimen. Do I Need to Change My Medications?

If you are already taking anti-HIV medications, talk with your doctor about the potential risks and benefits to your baby if you decide to continue your treatment regimen during your pregnancy. You and your doctor may decide to change your medications or change your medication dose. Make sure that your regimen includes the appropriate dose of ZDV.

In general, efavirenz (Sustiva), stavudine (Zerit), hydroxyurea, and the oral liquid form of amprenavir (Agenerase) should not be used during pregnancy.

Three-Part ZDV Regimen

HIV infected pregnant women should take ZDV starting at 14 to 34 weeks of pregnancy. You can take either 100 mg five times a day, 200 mg three times a day, or 300 mg twice a day.

During labor and delivery, you should receive ZDV intravenously (through an IV in the vein).

Your baby should take ZDV (in liquid form) every 6 hours for 6 weeks after he or she is born.

Will My Baby Be Born HIV Infected?

No one can tell you for sure if your baby will be born HIV infected. The three-part ZDV regimen has been shown to reduce the risk of passing HIV to your baby by almost 70%.

Additional anti-HIV medications can treat your infection and may provide extra protection for your baby. However, the possible problems with using multiple medications during pregnancy are not well understood.

Other actions to help you protect your baby include getting regular prenatal care and adhering to your HIV drug treatment plan (see Adherence and Adhering to a Regimen Fact Sheets).
 

I am HIV positive and pregnant. What delivery options are available to me when I give birth?

Depending on your health and treatment status, you may plan to have either a cesarean (also called c-section) or a vaginal delivery. The decision of whether to have a cesarean or a vaginal delivery is something that you should discuss with your doctor during your pregnancy.

How do I decide which delivery option is best for my baby and me?

It is important that you discuss your delivery options with your doctor as early as possible in your pregnancy so that he or she can help you decide which delivery method is most appropriate for you.

Cesarean delivery is recommended for an HIV positive mother when:

• her viral load is unknown or is greater than 1,000 copies/mL at 36 weeks of pregnancy

• she has not taken any anti-HIV drugs or has only taken zidovudine (also known as ZDV or AZT) during her pregnancy

• she has not received prenatal care until 36 weeks into her pregnancy or later

To be most effective in preventing transmission, the cesarean should be scheduled at 38 weeks or should be done before the rupture of membranes (also called water breaking).

Vaginal delivery is an option for an HIV positive mother when:

• she has been receiving prenatal care throughout her pregnancy

• she has a viral load less than 1,000 copies/mL at 36 weeks, and

• she is taking ZDV with or without other anti-HIV drugs

Vaginal delivery may also be recommended if a mother has ruptured membranes and labor is progressing rapidly.

What are the risks involved with these delivery options?

All deliveries have risks. The risk of mother-to-child transmission may be higher for vaginal delivery than for a scheduled cesarean. For the mother, cesarean delivery has an increased risk of infection, anesthesia-related problems, and other risks associated with any type of surgery. For the infant, cesarean delivery has an increased risk of infant respiratory distress.

Is there anything else I should know about labor and delivery?

Intravenous (IV) ZDV should be started 3 hours before a scheduled cesarean delivery and should be continued until delivery. IV ZDV should be given throughout labor and delivery for a vaginal delivery. It is also important to minimize the baby’s exposure to the mother's blood. This can be done by avoiding any invasive monitoring and forceps- or vacuum-assisted delivery.

All babies born to HIV positive mothers should receive anti-HIV drug treatment for prevention of mother-to-child transmission of HIV. The usual treatment for infants is 6 weeks of ZDV; sometimes additional drugs are also given.

 

AIDSinfo has developed a series of five fact sheets that discuss HIV and pregnancy in more detail. These fact sheets are available at www.aidsinfo.nih.gov/other/factsheet.asp.

For a Comprehensive Guide to HIV/AIDS and Pregnancy go to:

 HIV During Pregnancy, Labor and Deliver, and After Birth

This guide will help you answer any additional questions you may have.

 

For more Information visit:

The March of Dimes

Their mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. They carry out this mission through research, community services, education and advocacy to save babies' lives. March of Dimes researchers, volunteers, educators, outreach workers and advocates work together to give all babies a fighting chance against the threats to their health: pre-maturity, birth defects, and low birth weight.

The Body

This website provides information on treatment during pregnancy and a glossary of terms you may be unfamiliar with when first learning about HIV and pregnancy. It also provides a number of publications regarding pregnancy and HIV/AIDS.


>HIV/AIDS RESOURCES HOMEPAGE<

228 S. Muskogee Avenue   Tahlequah, OK 74464
Telephone: 918-456-6094   Fax: 918-456-8128   Email: peiron@niwhrc.org