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You should be in the best health possible before becoming pregnant. Visit our pregnancy section to learn what steps you can take now to give your baby the best chances for a healthy start to life.
Pregnancy and HIV/AIDS
- Take these steps to lower the risk of giving HIV to your baby
- HIV/AIDS drugs and pregnancy
- Paying for care while you're pregnant
- A short story: Heather and Stuart have a healthy baby
- More information on pregnancy and HIV/AIDS
Motherhood is a wonderful experience. Regardless of your HIV status, you may want to have children. HIV can be spread to your baby during the pregnancy, while in labor, 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, talk to your doctor right away. Your doctor can tell you how HIV can affect your health or your unborn baby's health. Your doctor can tell you how to prepare for a healthy pregnancy. There are ways for you to get pregnant that will limit your partner's risk of HIV infection. You can ask your doctor about ways to get pregnant without having unprotected sex with your partner.
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.
Just because you have HIV doesn't mean your child will get HIV. In the United States, before effective treatment was available, about 25 percent of pregnant HIV-positive mothers who didn't breastfeed and did not receive anti-HIV treatment in pregnancy passed the virus to their babies.
Today, the risk of giving HIV to your newborn is below 2 percent. But you and the baby must get the right HIV drugs at the right times. You also can't breastfeed. The steps below can lower the risk of giving HIV to your baby.
- Get as healthy as possible before becoming pregnant.
- Start HIV treatment before pregnancy if you need it for your own health. Or, you can start treatment during pregnancy to lower the risk of passing HIV to your baby. If you are already on treatment, do not stop, but do see your doctor right away. Some HIV drugs should not be used while you're pregnant. For other drugs, you may need a different dosage.
- Make sure your baby is tested for HIV right after birth. Your doctor or clinic should be experienced in managing babies who have been exposed to HIV. They will tell you what follow-up tests your baby will need, and when.
- Ask your doctor about starting treatment for your baby right away if your baby is diagnosed with HIV. This may require a number of tests and you may not know until he is 2 to 4 months old.
- Until you know that your baby is HIV-positive or HIV-negative, ask your pediatric HIV specialist if your baby might benefit from anti-HIV medicines. New research shows that putting a newborn on a 2- or 3-drug anti-HIV medicine plan cuts the infant's risk of HIV by 50 percent (compared to using one drug only).
- Ask your doctor about other medicines the baby may need to prevent opportunistic infections until you know for sure whether the baby has HIV.
Steps to lower the risk of giving HIV to your baby and have a healthy baby
Step 1: Get prenatal care
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.
Step 2: Stop smoking and drinking alcohol
Stop smoking and drinking alcohol. A mother's tobacco or alcohol use can cause very serious problems for the pregnancy and the baby, and can result in miscarriage or stillbirth.
Step 3: Take folic acid
Take folic acid. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida.
Step 4: Take HIV/AIDS medicines
Take HIV/AIDS medicines. Talk to your doctor about which HIV/AIDS drugs to take and when to take them. If you are already taking HIV drugs, ask your doctor whether you need to make any changes. Keep your viral load as low as possible by following your doctor's instructions exactly.
Step 5: Manage side effects
Manage side effects from the HIV/AIDS drugs; they may make it hard for you to take all your medications, but it is important that you do so. Talk to your doctors about ways to manage those side effects that you may be feeling.
Step 6: Get immunizations
Step 7: Eat healthy foods
Eat healthy foods. Talk to your doctor about any changes you need to make during pregnancy. Ask your doctor how much weight you should gain in your pregnancy.
Step 8: Get plenty of rest
Get plenty of rest. Backaches, heartburn, and the urge to urinate (pee) can make it hard for a pregnant woman to get a good night of sleep. But not only do you need enough sleep to take care of your growing baby, but you also have to keep your immune system strong. Ask your doctor if you're getting enough sleep, and listen to your body. Slow down when you are feeling tired.
Step 9: Lower the risk of passing HIV during delivery
Lower the risk of passing HIV during delivery. The most important way to decrease risk of passing HIV to your baby during delivery is to stick to your HIV medicines. You want your viral load to be undetectable when you deliver (you need a viral load test to find out). If you are not able to achieve that goal or if you start HIV drugs too late in pregnancy, your doctor may recommend a cesarean delivery or C-section so the baby doesn't touch your blood. If you have a C-section, you will deliver at 38 weeks to avoid labor and having your water break around your baby.
Step 10: Do not breastfeed
Do not breastfeed. You can pass the virus to your baby through your breast milk even if you are taking medications.
Step 11: Make sure your baby gets HIV drugs on time
Make sure your baby gets HIV drugs on time. Make sure your baby gets the right HIV medication after delivery and that your baby gets every dose.
Step 12: Continue your own medication after delivery
Continue your own medication after delivery. Even though you will be focusing on your baby and getting less sleep, you must continue to take all of your HIV medicine on time, every day. Talk to your doctor or counselor if you need extra support or find that you are forgetting to take your medicine.
HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby, and in some cases, improve the mother's own health. Research has shown that taking combination HIV drugs is better at preventing HIV in newborns than taking AZT alone.
If you haven't used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Some things you can talk about with your doctor include:
- Nausea and vomiting early in your pregnancy may make it hard to start the HIV drugs.
- It is possible the drugs may affect your developing fetus. Your doctor will guide you.
- HIV is usually passed to a baby late in pregnancy or during delivery.
- Studies show that treatment works best at preventing HIV in a baby if it is started before 28 weeks into pregnancy.
Talk to your doctor about your health and the pros and cons 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. Some things you can talk about with your doctor include:
- Whether to continue or stop HIV treatment in the first trimester. 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 get worse and cause problems for your baby. So this is a serious decision to make with your doctor.
- What potential effects your HIV medicines may have on the developing fetus.
- Whether you are at risk of developing drug resistance. Stopping HIV drugs without a firm plan from your doctor can lead to drug resistance. That is when the drugs don't work anymore against HIV. Never stop the drugs on your own without an OK from your doctor.
During your pregnancy, you and your doctor will not just discuss whether you should keep taking your HIV medicines. Your doctor may need to adjust your type or dosage of 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
- Your weight
- What is known and not known about the effects of the drugs on the fetus
- Best treatment for your own health with HIV
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 Treatments for HIV/AIDS for more information on HIV medicines.
If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and HIV-positive, this program might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. Each state makes its own rules regarding health care assistance. If you don't think you qualify for assistance, check again. Under health care reform, Medicaid eligibility will expand to cover many more people starting in 2014. Also, you may be able to get Medicaid because the income limits will be raised for pregnant women 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. If you are unable to find that number, search your state's department of health.
A short story: Heather and Stuart have a healthy baby
Heather and her boyfriend, Stuart, have been together for two years. This year, when Heather found out she was pregnant, she also learned that she is HIV-positive.
Dr. Murphy: Hi Heather. Congratulations on your pregnancy! Your regular doctor told me that you and your boyfriend, Stuart, were both diagnosed with HIV. I have a lot of pregnant patients who have HIV. As long as we diagnose early and take the right steps, the baby has a very high chance of being born HIV-free.
Heather: I would feel better knowing that I could do something to help make sure the baby will be healthy.
Dr. Murphy: There are drugs you can take while you're pregnant to help keep the baby from getting HIV. We need to decide when the best time is for you to start HIV treatment. Because you do not need treatment right now for your own health and you have not taken HIV drugs before, you might want to wait to start treatment. During the first trimester, when the baby is forming, the drugs might hurt the baby's organs. Besides, HIV is more likely to be passed later in your pregnancy, and that's when the drugs will be most useful.
Heather: So if I take a drug, my baby won't get HIV?
Dr. Murphy: It's not one hundred percent, but the chances are very low. Most babies born to HIV-positive mothers in the United States do not end up getting HIV, and your chances are very good.
Another way to lower the chance is to have your baby by C‑section. But you may not need one if your viral load is low enough and you get the right treatment. We can talk more about this down the road. In the meantime, you're going to have a lot of questions and worries about being pregnant and having HIV. I'll give you the name of a counselor who can help you understand and manage HIV in your daily life.
Heather went home and talked to Stuart about her doctor appointment.
Heather: I'm just so worried about the baby.
Stuart: Didn't the doctor say that if you take HIV medicine, the baby won't get HIV?
Heather: She said the chances of the baby getting HIV are very small. So I am going to take the drugs.
Stuart: We'll find a way to get through this. We'll do everything we can to make sure our baby is healthy.
Heather: I wish we had both gotten tested for HIV earlier. But I'm glad we called our former partners and that everyone got tested. I'm glad we are taking care of ourselves, and that we know how to keep the baby safe.
Over the next few months, Heather continued seeing Dr. Murphy and also starting seeing a psychologist, Dr. Wells, who works with patients who have HIV.
Dr. Wells: So, how have you been feeling this week?
Heather: The baby is kicking a lot, but I'm feeling good. I'm just really worried about the baby and feel guilty about not having prevented this.
Dr. Wells: Your feelings are normal. But remember, you have done all you can to have a healthy baby. You have been taking the HIV drugs, you've been eating right, and exercising. Your baby has a very good chance at being born completely healthy!
Heather: I am glad I found out about the HIV infection, and that I can take steps to keep the baby and myself healthy.
Dr. Wells: Being proactive about your health with HIV is so important. You can live a long and full life with HIV nowadays, and if you take care of yourself you can plan to be around for your child for a long time!
Heather's doctor recommended she have a vaginal delivery because her viral load was undetectable. This means that even though Heather still has HIV, her chances of passing it to the baby are extremely small. Heather and Stuart are looking forward to the delivery.
Heather: I can't believe our baby is coming in two weeks!
Stuart: I know! I am so proud of you for making it this far.
Heather: I am proud of you too. You have taken good care of me and of yourself for our baby. I'm glad you are taking the HIV drugs too. We'll be OK.
Stuart: Even though we have this disease, I have a lot of hope for our future.
When it was time to deliver the baby, Heather and Stuart headed to the hospital.
Dr. Murphy: Congratulations! You have a beautiful baby girl. We won't know her HIV status right away, but we will take a couple of tests and get back to you with the results. We will do the first test in a couple of weeks, another HIV test in about a month, another one when she is about 4 months old. Basically we need two matching test results in a row to be sure.
We will also give her some medicine that can help keep her from getting HIV. If it turns out that your baby girl has HIV, we will want to start HIV treatment right away.
Heather and Stuart were happy that baby Emily's first two HIV tests were negative. Their daughter definitely did not have HIV.
Heather and Stuart breathed a sigh of relief.
Dr. Murphy: Looks like everything you did to have a healthy baby worked. Keep bringing your baby in for her visits. You might want to enroll baby Emily in a study that looks at the long-term effects of HIV drugs taken in pregnancy to prevent passing HIV. These studies help us learn whether there are long-term side effects of the HIV drugs on the baby and how to treat them. And keep taking good care of yourselves, including taking your HIV medicines as planned, so your whole family stays healthy!
Explore other publications and websites
HIV and Pregnancy — 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.
HIV Infection in Infants and Children — This publication describes HIV in children, including information about transmission and diagnosis. It also talks about the progression of the disease, signs and symptoms of pediatric HIV, and treatment of children with HIV/AIDS.
HIV/AIDS During Pregnancy (Copyright © American Pregnancy Association) — This Web page from the American Pregnancy Association answers questions about how HIV affects pregnancy.
Infant Feeding and HIV (Copyright © UNICEF) — This 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 without breastfeeding.
Mother-to-Child (Perinatal) HIV Transmission and Prevention — This fact sheet talks about mother-to-child HIV transmission during pregnancy, labor and delivery, and breastfeeding. It discusses how mothers can lower the risk of perinatal transmission of HIV.
National HIV and STD Testing Resources — This website has information and resources on HIV testing, including a national database of HIV testing sites. It also provides basic information about HIV/AIDS and behaviors that place a person at risk of infection.
Standby Guardianship (Copyright © Family Ties Project) — Standby guardianship allows parents to make future plans for their children without having to legally transfer decision-making power. This website provides information on the Standby Guardianship Act of 2002 in the District of Columbia and information and resources on similar legislation in other states.
Women, Children, and HIV (Copyright © UCSF, UMDNJ) — This website 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.
Connect with other organizations
Administration for Children and Families
Center for AIDS Prevention Studies, ARI, UCSF
Centers for Disease Control and Prevention, HHS
Elizabeth Glaser Pediatric AIDS Foundation
Family Ties Project
March of Dimes
National Institute of Child Health and Human Development, NIH, HHS
Content last updated July 1, 2011.
Resources last updated July 1, 2011.
A federal government website managed by the Office on Women's Health in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services.
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