HIV and pregnancy

Can HIV-positive women plan families and get pregnant?

Are you living with HIV and interested in having children? You are not alone. The majority of HIV-positive women are of child-bearing age. Advances in HIV treatment have greatly lowered the chances that a mother will pass HIV on to her baby. The risk of passing HIV from mother to baby can be as low as 1 in 100 when certain steps are taken.

In most cases, HIV will not cross through the placenta from mother to baby. If the mother is healthy in other aspects, the placenta helps provides protection for the developing infant. Factors that could reduce the protective ability of the placenta include: in-uterine infections, a recent HIV infection, advanced HIV infection, or malnutrition.

Unless a complication should arise, there is no need to increase the number of prenatal visits. Special counselling about a healthy diet should be part of the prenatal care for all women. For HIV-positive women,  special attention should be given to preventing iron or vitamin deficiencies and weight loss. Further, special interventions for sexually transmitted diseases or other infections (such as malaria, urinary tract infections, tuberculosis or respiratory infections) should be assessed. 

Health care providers should watch for symptoms of AIDS and pregnancy-related complications of HIV infection. In addition, providers should avoid performing any unnecessary invasive procedures such as amniocentesis in an effort to avoid transmitting HIV to the baby.

A baby can become infected with HIV in the womb, during delivery, or while breastfeeding. If the mother does not receive treatment, 25% of babies born to women with HIV will be infected by HIV. With treatment, this percentage can be reduced to less than 1%.

Zidovudine (ZDV) is now used in combination with other anti-HIV drugs. ZDV is often used to prevent perinatal transmission of HIV. ZDV should be given to HIV-positive women at 14 weeks along in their pregnancy, and continued throughout pregnancy, labour, and delivery. The side effects of ZDV include: nausea, vomiting and low red or white blood cell counts.

If no preventative steps are taken, the risk of HIV transmission during childbirth is estimated to be 10-20%. The chance of transmission is even greater if the baby is exposed to HIV-infected blood or fluids. Health care providers should avoid performing an amniotomy (intentionally rupturing the amniotic sac to induce labour), an episiotomy and other procedures that expose the baby to the mother’s blood. The risk of transmission increases by 2% for every hour after membranes have been ruptured.

Caesarean sections performed before labour and/or the rupture of membranes may significantly reduce the risk of perinatal transmission of HIV.

Women who have not received any drug treatment before labour should be treated during labour with one of several possible drug regimens. These may include a combination of ZDV with anti-HIV drugs. Studies suggest that these treatments, even for short durations, may help reduce the risk to the baby.

The baby should also be treated with ZDV for the first 6 weeks of their life. 8 percent of babies of women treated with ZDV become infected, compared with 25% of babies of untreated women. No significant side effects of the drug have been observed other than a mild anaemia in some infants that cleared up when the drug was stopped. Follow-up studies show that the HIV-negative treated babies continued to develop normally.

15% of newborns born to HIV-positive women will become infected if they breastfeed for 6 months or longer.

The risk of transmission is dependent upon:

• Whether the mother breastfeeds exclusively.
• The duration of breastfeeding.
• The mother’s breast health.
• The mother’s nutritional and immune status.

The risk is greater if the mother becomes infected with HIV while she is breastfeeding.

• A woman who is HIV-negative or does not know her HIV status should exclusively breastfeed for 6 months.
• A woman who is HIV-positive and chooses to use replacement feedings should be counselled on the safety and appropriate use of formula.
• A woman who is HIV-positive and chooses to breastfeed, should exclusively breastfeed for 6 months. The woman should also be advised regarding the changing risks to her baby during those six months, preventative treatments available and early treatment of mastitis and oral problems, weaning plans and how to determine the appropriate time to switch to formula feeding.

Despite the numbers of HIV-positive people who want to get pregnant, there is limited access to information, options, and therapies. Many healthcare providers do not discuss family planning with their HIV-positive patients. Some do not have adequate information to share, while others openly discourage their HIV-positive patients from having children. Despite the challenges you may face when wanting to get pregnant, it is possible for HIV-positive people to have children. When choosing to have a child as an HIV-positive person, it is important to be an advocate for yourself and your future child. Finding the right health care provider who is supportive of your plans to get pregnant is a big first step.

This column is authored by Dr Avron Urison, Medical Director at AllLife Pty Ltd* – providers of life insurance for HIV positive individuals.

*AllLife is an Authorised Financial Service Provider. Products are underwritten by Centriq Life Insurance Company (RF) Limited.

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