it safe to be HIV+ and Pregnant?
Of course, as is the case with the rest of HIV and its
treatment, they are no absolute certainties or across
the board truths. Every woman is different.
there's no data suggesting that pregnancy accelerates
the rate of HIV disease progression. HIV by itself won't
stop you from having a safe pregnancy. If you're generally
healthy, get good prenatal care, and are careful to
avoid risk factors, your chances of avoiding things
like premature delivery and birth defects are not significantly
different from those of your HIV-negative counterparts.
can be hard to deal with the judgemental attitudes of
people, including doctors, who think that it is morally
wrong for HIV-positive women to get pregnant. The good
news is that there are many strategies for dramatically
reducing the risk of passing the virus to your infant
- often referred to as perinatal or vertical transmission
- which you and your doctor should be ready to discuss.
If your health-care provider isn't supportive or is
being judgmental, it's your right to find someone who
will be supportive.
are the risks of Transmitting HIV?
HIV-positive pregnant woman - provided that she does
not take nay anti-HIV medications - has a 25% chance
of passing HIV to her baby. However, if she takes anti-HIV
drug therapy while she is pregnant, the risk of her
passing the virus to her baby is much lower - in some
cases as low as 2%.
Does Transmission Work?
are not exactly sure when babies are infected with HIV
during pregnancy. It has been said that a small percentage
of all babies are infected with HIV with developing
inside their mothers uteruses. However, this has not
really been proven. It is known that the vast majority
of infections occur during labor or after the body is
born and is breast-fed by his or her HIV-infected mother.
pregnancy, a developing fetus has his or her own blood
supply. In other words, the developing fetus does not
come into contact with the blood of his or her mother.
This helps protect the fetus from infections in the
mother's blood, such as HIV. However, developing fetuses
do receive nutrients and various proteins, such as immune
system antibodies, from their mothers. While a mother's
HIV may not enter the fetus, her antibodies to the virus
will. These antibodies cannot harm the fetus, but will
cause the baby to test "positive" to an HIV
antibodies test when he or she is born.
the time of birth, a baby often comes into contact with
his or her mother's blood. If the mother's blood enters
the baby's body, this is when HIV can be transmitted.
all babies born to HIV-infected Mothers Test Positive
for the Virus?
they do. It is important to keep in mind what the HIV
test is. These tests look for antibodies to HIV, they
do not look for the virus itself. Because a fetus is
exposed to his or her mother's HIV antibodies, he or
she will automatically test "positive" after
birth. These antibodies can remain in the baby's body
for more than 18 months after he or she is born.
hospitals now test babies born to HIV-infected women
using "PCR". This test can be performed within
a few days after delivery and looks for HIV itself in
a blood sample collected from the baby. If the test
is negative, it should be repeated within a few months
after the birth to look for HIV.
is Prenatal Care So Important?
pregnant woman, regardless of her HIV status, should
see a doctor regularly to receive prenatal care. Simply
put, prenatal care is a specialized type of health care
designed to protect the health of both the woman and
her developing baby. Prenatal care can help all pregnant
women figure out what they should do to improve their
diets and vitamin/mineral intake and to reduce unhealthy
habits such as smoking, drinking alcohol, and doing
a pregnant woman does not know whether or not she's
HIV positive, most prenatal care programs now recommend
HIV testing. While some states are hoping to make HIV
testing a requirement for all pregnant women, no prenatal
care program has the right to test a pregnant woman
for HIV without her consent. In New York State, the
law allows for any newborn baby to be tested for HIV,
regardless of whether or not the baby's mother permits
the test to be performed.
a pregnant woman finds out that she is positive while
she is pregnant, or knew that she was positive before
getting pregnant, prenatal care programs can help protect
her health and the health of her developing baby. Usually,
a prenatal care program calls for monthly visits to
a clinic or doctor's office for the first eight months
of pregnancy. During the eighth and ninth months of
pregnancy, visits are more frequent, typically every
care for women who are HIV infected may include T-cell
counts and viral loads tests, treatments to prevent
AIDS-related infections, anti-HIV drug therapy, management
of drug side effects, and importance nutritional care.
women might want to avoid some aspects of typical prenatal
care. For example, amniocentesis, used to test for genetic
defects in the baby, is done with a needle that passes
through the mother's abdomen and into the womb. While
this test may be necessary to look for any genetic problems
that a developing baby may have, it can also increase
the risk of transmitting HIV.
can you Reduce the Risk of Transmission?
the following sections, we'll discuss three topics that
a pregnant woman should discuss with her doctor that
can reduce the risk of transmission to her baby anti-HIV
drug therapy. Cesarean sections, and the risk of breast-feeding.
pregnant women who are infected with HIV, the topic
of anti-HIV drugs will most definitely come up as a
part of a prenatal care program. These drugs, if taken
correctly, can drastically reduce the amount of HIV
in a mother's blood at the time of birth. This can help
reduce the chances of passing the virus along.
sections - an operation in which the baby is removed
through an incision in the belly - reduces the amount
of time the baby comes into contact with his or her
mother's blood and has been shown to reduce the risk
of transmitting HIV.
breast milk can also transmit HIV, formula feeding,
whenever clean water and formula are available, is strongly
about Anti-HIV drug therapy?
one anti-HIV drug - Retrovir - has been approved by
the U.S. Food and Drug Administration for the prevention
of mother-to-infant HIV transmission. According to a
major study conducted several years ago about the National
Institute of Health, Retrovir therapy can reduce the
risk of perinatal transmission from 25% to approximately
8%. While there are no guarantees that Retrovir therapy
will prevent HIV from being transmitted from a mother
to her baby, if greatly reduces this chance that transmission
therapy during pregnancy is a three-part program :
A standard dose of the drug is started after the first
trimester of pregnancy. In other words, and HIV-infected
pregnant would should take Retrovir for Six months
prior to giving birth to the baby. The dose is one
300 mg tablet taken twice a day.
the time of delivery, whether it is by vaginal birth
or C-section, higher doses of Retrovir are administered
through an intravenous line.
liquid form of Retrovir is given to the baby immediately
after birth and continued for six weeks.
this the Only Regimen Available?
are still looking at other ways to use Retrovir to prevent
mother-to-child transmission. For example, one study
has already demonstrated that one does of Retrovir given
either to the mother during labor or to the newborn
within 48 hours after birth, reduced the risk of transmission
by more than half.
from another study suggest that giving a single dose
of Virmune to both mother and newborn infant reduces
transmission rates by nearly 50%. This study was actually
conducted in African women, many of whom do not receive
adequate prenatal care. Nevirapine is current being
studied in the United States and, if used in the setting
of prenatal care or in combination with other anti-HIV
drugs, the drug may prove to be very effective in reducing
the risk of mother-to-child HIV transmission.
about Combination Anti-HIV Therapy?
and more women are taking combinations of anti-HIV therapies
to keep themselves healthier and alive longer. Effective
combination therapy can lower viral load to below the
limits of detection and ease the pressure on the immune
system. Not only are the effects of combination therapy
good for the mother, they have also been said to further
reduce the risk of transmitting HIV.
what is known about Retrovir, it is recommended that
any combination of drugs used during pregnancy include
out whether or not to start combination therapy - or
remain on combination therapy - is a difficult decision
for all HIV-infected pregnant women. If you are HIV-positive
and pregnant, here are some questions you should consider
discussion with your doctor before starting combination
How have you been feeling?
was your most recent T-cell count?
was your most recent viral load?
your doctor think that you/re at risk for developing
course, HIV-infected pregnant women will want to consider
how the drugs they're thinking of taking might affect
the baby. There's new research being produce all the
time about the safety and tolerability of different
medications for pregnant women and their developing
about the Potential side effects of Combination Therapy?
who is HIV-positive and taking an anti-HIV drug combination
faces the risk of side effects. HIV-infected pregnant
women are no different. Side effects include metabolic
changes and lipodystrophy, which can cause an increase
in blood levels of flats and sugars. By itself, pregnancy
is a risk factor for elevated glucose levels. It's not
yet known if anti-HIV medications increase the risk
of these metabolic problems occurring in pregnant women.
anti-HIV drugs can cause liver damage, such as increases
in the liver enzyme bilirubin. Too much of this enzyme
can harm a fetus. While most HIV-infected people taking
a protease inhibitor only experience mild increases
in this enzyme, pregnant women taking these drugs -
especially the protease inhibitor Crixivan - should
be extra careful and have their bilirubin levels checked
possible side effect of combination therapy is pre-term
delivery. In early clinical trials, some women who used
a combination of anti-HIV drugs that included protease
inhibitors gave birth to their babies earlier than they
should have. This can cause health problems for the
baby. However, a number of studies conducted in recent
years have not found that HIV-positive women receiving
combination therapy are any more likely than other women
to give birth to pre-term babies. But there is a risk.
has also been concern about the drug efavirenz Sustiva.
Pregnant monkeys who received this drug gave birth to
babies with deformities, some of them quite severe.
However, a number of HIV-infected pregnant women have
used this drug and, to date, none have given birth to
babies with the same deformities seen in the monkey
experiments. Again, there is a risk of damage and many
experts do not recommend this drug for HIV-infected
drugs, especially the nucleoside analogues, can damage
the mitochondria- the tiny "powerhouses" inside
cells that provide cells with energy. Cells that contain
too many severely damaged mitochondria must resort to
an abnormal type of energy production that doesn't rely
on the mitochondria. Lactic acid is the chemical byproduct
of this sort of abnormal energy production. If too much
lactic acid builds up in the body, serious illness can
occur, including fatigue, nausea/vomiting, painful inflammation
of the pancrease, and liver damage.
cases of lactic acidosis can be deadly. The U.S. food
and drug administration ahs issued an important warning
that HIV-positive women should not take Zerit and Videx
or Videx EC at the same time if they are pregnant. Some
pregnant women who took these drugs together developed
lactic acidosis, some of whom died. It is not clear
if any of the other nucleoside analogues cause lactic
acidosis in women or mitochondiral damage in babies
born to mothers taking these drugs. Fortunately, Retrovir
has been studied for many years in pregnant women and
babies and has not been shown to cause any of these
if I Become Pregnant While I'm on Therapy?
you become pregnant while you're receiving anti-HIV
drug therapy, you have several options. The first is
to stay with your combination. If it's working - that
is, it's keeping your viral load at or near undetectable
levels and doesn't cause you lots of side effects -
staying on therapy might be a good option. A recent
review of roughly 3,500 pregnancies in HIV-positive
women found that the rates of "adverse events"
- complications during or after pregnancy- weren't increased
in women who took combination therapy.
may also consider stopping therapy for the first three
months of your pregnancy to minimize fetal exposure
to drugs during the earliest stages of development.
After the first three months, you can restart your old
regimen. Or, you may choose to stay off therapy altogether
for the remainder of your pregnancy. No matter what,
you should strongly consider taking AZT to reduce the
risk of transmission.
you've been having a hard time taking all your pills,
or if the side effects are really bothering you, it
may be a good idea to stop, at least for the beginning
of your pregnancy. There's no way of knowing how you'll
feel while you're pregnant - morning sickness on top
of daily drug-related nausea could be the last straw.
Stopping a complicated drug regimen also minimizes the
risk of developing drug -resistant virus, which can
limit your subsequent treatment options, and could even
get passed on to your baby.
word of caution: Accidents happen. Some oral contraceptives
- birth-control pills - do not mix well with some anti-HIV
drugs. For example, efavirenz can increase blood levels
of oral contraceptives and, in turn, may increases the
side effects of the hormones found in these pills. The
protease inhibitors ritonavir and nelfinavir can decrease
the amount of oral contraceptives in the blood. This
can increase the chance of becoming pregnant. If you're
trying to avoid pregnancy, it might be best to use a
barrier method - e.g., condoms, diaphragm, etc - while
using anti-HIV drugs.
HIV+Pregnant Women have drug - resistance Tests?
that the goal of anti-HIV drug therapy is to reduce
viral load to undetectable levels - preferably to less
than 50 copies/mL - all HIV-positive pregnant women
should consider having a drug resistance test if their
viral load becomes detectable while receiving therapy.
These tests can determine which drugs are no longer
working and help figure out which drugs to switch to.
In this way, drug-resistance tests are valuable for
anyone who is receiving anti-HIV drug therapy, not just
About Cesarean Sections?
Section - often called a "C-section" - is
a type of surgery that has been said to greatly reduce
an HIV-positive woman's risk of passing along the virus
to her baby at the time of birth. However, it is still
not known if C-sections are nay more effective than
taking a powerful andit-HIV drug combination in reducing
this risk. It is also not known if a woman who takes
a powerful anti-HIV drug combination and has a C-section
has a lower chance of passing along the virus to her
baby than a woman who takes anti-HIV drugs and has a
perform a C-section, a needle is inserted into the woman's
spine and injected with morphine. This causes numbness
from the waist down, allowing the doctor to make a long
incision under the bellybutton to remove the baby.
is also a surgical procedure called a "bloodless
C-section". This type of surgery goes a sleep further
than regular C-sections. In a bloodless C-section, the
blood vessels near the womb are weided, or "cauterized",
using a laser to prevent them from bleeding. This procedure
lowers the risk that the baby will come into contact
with his or her mother's blood.
experts do not like the idea of C-sections. Because
C-sections are a type of surgery, there are risks of
infection and other complications. It is also important
to remember that a combination of anti-HIV-drugs - which
may include AZT plus two other drugs - might do a better
job of stopping transmission, without even needing a
C-section. According to some studies, in HIV-positive
pregnant women who have an undetectable viral load at
the time of birth, the risk of delivering a baby infected
with the virus is less than 2%. Again, it is not known
if C-sections reduce this risk any further.
doctors - particularly obstetricians and gynecologists
- recommend to their HIV-infected pregnant patients
that they have a C-section to deliver their babies.
However, it is important that HIV-infected pregnant
C-sectors are an option, not a requirement. No
patient should ever be forced to have a surgical procedure.
An HIV-infected pregnant woman has the right to refuse
If a doctor has recommended a C-section, he or
she should explain the procedure and discuss the possible
benefits and the potential risks.
about breast - feeding?
milk carries HIV too, and breast-feeding adds considerable
risk of transmission. As with transmission via blood,
there's some indication that risk increases along with
viral load. So far, research shows that the risk of
breast milk transmission is highest in the first six
months of life. However, there's no threshold or time
point beyond which it becomes absolutely safe to breast
clean water and formula are available. It's recommended
that HIV-positive women exclusively formula feed their
the past year, a handful of studies have also looked
at breast milk pasteurization, a procedure that allows
women to express their breast milk and treat it themselves
so that it becomes safe for their infants to drink.
Right now, these studies have been done in resource-poor
settings; your doctor may have more information about
Else Can I Do?
good advice for people with HIV is great advice for
pregnant women: take good care of yourself and gets
lots of support. Support can mean a lot of different
things, but it definitely means having someone to talk
to someone who can listen, who won't judge you and your
decisions, and will help you figure out what to do when
things get murky. This could be a counselor, family
member, partner or friend. Ideally, it will be a collection
of these folks.
for a team of people to work with you: a good OB/GYN
and an HIV specialist, and possibly a case manger who
will help you navigate whatever benefits and services
you need during and after your pregnancy. Find a nutritionist
who can help you satisfy your cravings - and will also
help you to eat right. And talk, talk, talk to other
positive mothers about their experiences. Be sure you
have a plan for yourself and the baby so you're prepared
after the birth.
great care of yourself while you're pregnant is important
- but it's just as important that you pay attention
to yourself after your baby is born. Lots of women have
trouble keeping to their pill schedules once the whirlwind
of nursing and feeding and cleaning begins. It's fine
to stop all your drugs. Just discuss it with your doctor
first. Or, you may want to switch to a simpler regimen.
Just remember, your health matters too. Look for ways
to make things more manageable - for instance, some
clinics are set up so that you and your baby can have
doctor's visits on the same day.
of all, do whatever you need to feel good about yourself.
Trust your instincts. Take time to pamper yourself.
You, and your baby, are worth it.