6 HIV and pregnancy

6.3 HIV and pregnancy overview

---

Can HIV-positive women become mothers safely?

Yes. Using anti-retroviral (ARV) drugs, an HIV positive woman can safely become pregnant with very little risk of transmitting the virus to her baby.

Many thousands of women have taken therapy during pregnancy without complications to their babies.

This has resulted in many HIV-negative babies.

How is HIV transmitted from mother to a baby?

The exact way that mothers pass HIV onto babies is still unknown. Without treatment, about 1 in 4 babies born to HIV-positive women will be HIV-positive.

The majority of transmissions occur near the time of or during labour and delivery. Transmission can also occur through breastfeeding.

Certain factors seem to make transmission during labour much more likely.

Viral load is the strongest risk factor

If a woman has a high viral load the risk of transmission to her baby is much greater than if it is very low .The aim of the HIV drugs is to make sure that her viral load is as low as possible, particularly at the time of delivery. This will also give the most benefit to the mother herself if she needs treatment for her own HIV.

Other risk factors

Premature birth, lack of prenatal HIV care, the time between when the mother's waters break and the actual delivery (called duration of ruptured membranes).

The mother’s health directly relates to the HIV status of the baby

Whether the baby’s father is HIV-positive will not affect whether the baby is born HIV-positive

Do HIV drugs protect the baby?

Yes. Using a combination of 3 or more ARV drugs gives a transmission rate of less than 1%.

Reducing the risk of a baby becoming HIV-positive was an early benefit of ARVs.

• PACTG 076 was the first study to show that using the drug AZT could protect the baby from HIV.
• Mothers took AZT before and during labour.
• The baby received AZT for six weeks after birth.
• This reduced the risk of the baby becoming HIV-positive from 25% to 8%.

From 1994, this strategy was recommended for all HIV-positive pregnant women in Western Europe and North America. But even further advances have been made over the last few years.

Treat as non-pregnant adult

This is a very commonly used phrase. This means that generally your HIV is treated as if you are not pregnant. There are some exceptions- particularly when you do not need treatment for your own HIV and concerning some of the commonly used HIV drugs.