HIV Transmission from Mother to Child
The Bottom Line: HIV-positive people can have healthy, HIV-negative children but it takes some planning.
HIV can be transmitted from mother to child during pregnancy, childbirth, or during infancy from breastfeeding. If a mother does not know she is HIV-positive or gets no care or treatment to prevent transmission to her child, the risk of a baby acquiring HIV from its mother is about 1 in 4.
There are very effective ways of preventing mother-to-child transmission, especially if HIV is diagnosed before or early in the pregnancy and if the mother receives the proper care and medications throughout pregnancy, childbirth, and afterward. With recommended treatment, fewer than 1 in 100 babies born to HIV-positive mothers will get HIV. The risk of transmission during and after pregnancy is lowest if the mother is stable on HIV medications, with an undetectable viral load throughout her pregnancy. Women living with HIV in the U.S. are also counseled to avoid breastfeeding.
Conception and Preparing for Pregnancy
In general the best advice is that having children can be very safe if you or your partner are HIV-positive; however, getting ready for a pregnancy can take some extra planning. It is always a good idea to discuss your plans with your doctor before you start trying to conceive.
If the mother is HIV-positive: Talk with your doctor about planning a pregnancy. Some HIV medications are recommended during pregnancy more than others so you may or may not need to consider switching HIV-treatment regimens. Your doctor can also advise you about what kinds of pre-natal vitamins to consider and how to go about conception in the safest way possible if your partner is HIV-negative.
If the father is HIV-positive: It is always a good idea for you (or you and your partner) to talk with your doctor before planning a pregnancy. If your partner is HIV-negative, your doctor can help advise you about the safest ways to try to conceive. Something to know is that an HIV-positive man cannot give HIV directly to a baby. A baby can only be born with HIV if its mother is HIV-positive. Therefore, if your partner is HIV-negative, your priority will be to keep your partner HIV-negative throughout conception and pregnancy. If your partner is HIV-positive, it will be important for her to discuss her pregnancy plans with her doctor to get ready.
Pregnancy and HIV
There are lots of ways to stay healthy during pregnancy and many of those things are no different for an HIV-positive woman than for any other pregnant woman. Seeing a midwife or traditional healer/birth attendant can be a great thing. Nevertheless, you will want a provider who specializes in HIV to help with monitoring your pregnancy and getting ready for childbirth and the first few months of your baby’s life. Some women choose to see an OBGYN doctor who specializes in HIV during pregnancy if that is an option. Madison Clinic works closely Dr. Jane Hitti, on OBGYN physician who specializes in the care of HIV-positive pregnant women. In other places, an HIV-positive woman may stay with her normal HIV provider and see a midwife, OBGYN, or other traditional practitioner to complement her pre-natal care.
The main way to prevent mother-to-child transmission is to stay on a safe HIV medication regimen and keep an undetectable viral load. If you keep an undetectable viral load, then it can be safe to have a vaginal delivery (if you don’t have other reasons to need a cesarean-section (“C-section”)). For women who have a high viral load or an unknown viral load (who haven’t gotten a blood test for several weeks) late in their pregnancy, a scheduled C-Section is recommended at 38 weeks.
After birth, women in the U.S. are currently advised to refrain from breastfeeding. In addition, your baby will likely be given an HIV medication, zidovudine, for about six weeks after they are born.