Prenatal Care for the HIV Positive Woman

HIV infection no longer prevents a couple from having children. With the proper planning and medical care and by taking good care of herself during the pregnancy, an HIV+ woman can look forward to a long and healthy life for herself and her child. If an HIV positive woman is pregnant, she has hopefully planned the pregnancy and discussed the appropriate HIV treatment and medical precautions that must be taken to minimize the risk of transmission of HIV to her baby with her HIV specialist and with her obstetrician. By instinct, most women will do whatever it takes to care for their unborn children. Good prenatal care and monitoring is essential for any woman, but especially for the HIV+ woman.

Pregnancy and HIV disease: Pregnancy does not affect the course of HIV disease in any way. It will not make the HIV better or worse. The CD4+ cell count will drop during pregnancy, which is normal for any woman, regardless of HIV status, but this will return to the pre-pregnancy levels after delivery. If the CD4+ cell count drops too low, the woman may need additional medications to prevent opportunistic infections.

Mother-to-Child Transmission of HIV: If a woman is HIV+, the virus can be transmitted to the baby while the baby is in the uterus, during labor and delivery, or through breastfeeding. The factors that can reduce the transmission for each of these situations will be discussed. Overall, with proper medical care, the rate of mother-to-child transmission in the U.S. is less than 2%.

HIV medications and Pregnancy: Certain HIV medications, as well as other medications, can result in birth defects; hopefully the woman has discussed her pregnancy plans with her HIV treatment specialist and is on an appropriate regimen of antiretroviral medications (ARV) before she conceives, if they are needed. If so, she may continue with these medications as long as she is able to be adherent to them consistently throughout the pregnancy, or she may discuss stopping the medications until after the first trimester, when organ development of the baby is complete. If a woman is not on HIV medications, she should be at some point during the pregnancy; an undetectable HIV viral load decreases the risk for transmission to the baby during the pregnancy and during delivery. Most often, the ARV medications will not be started until after the first trimester; morning sickness may make it difficult to adhere to medications initially, and the effects of ARV medications on the development of the baby are not fully known. Click here to view the current U.S. Department of Health and Human Services Guidelines for ARV therapy during pregnancy.

Delivery: Today, HIV+ women who are on effective ARV therapy and whose HIV viral load is undetectable, vaginal delivery is a viable option; under these circumstances, the risk of transmission is about the same as with a C-Section, and the C-Section carries with it the risk of any major surgery. If a woman is not on ARV therapy or if her viral load is >1,000 at the time of delivery, however, a C-Section becomes necessary to reduce the risks of transmission of HIV to the baby. The method of delivery will be decided upon after the woman and her treatment specialists discuss her particular situation and the risks and benefits of each method. Through careful planning and by following the advice of an experienced HIV treatment specialist, HIV+ women can now fulfill their hopes and dreams of having happy, healthy children. Future posts will discuss the care of the newborn, including HIV testing.