Pregnancy

Women & HIV/AIDS

Pregnancy

Motherhood is a wonderful experience. Regardless of your HIV status, you are a woman first and may want to have children. Because HIV can be spread to your baby during the pregnancy, while giving birth, or by breastfeeding, you will have many choices to make about lowering the risk of passing HIV to your baby.

If you want to become pregnant, the best first step you can take is to talk with your doctor. Your doctor can tell you how HIV or other health conditions and risk factors you might have could affect your or your unborn baby’s health. Your doctor can tell you what you can do now to be sure your pregnancy is planned and to help prepare your body for a healthy pregnancy. If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor’s help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps before and during your pregnancy to help you and your baby stay healthy:

• Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida.
• Keep your viral load as low as possible by staying on the medicine your doctor has given you.
• Manage side effects from the HIV/AIDS drugs.
• Get immunizations if you need them to prevent opportunistic infections (OIs) like the flu or pneumonia.
• Stop smoking and drinking alcohol.
• Eat healthy foods.
• Get plenty of rest.

HIV/AIDS Drugs and Pregnancy

Pregnant women should take HIV medicines to lower the risk of passing HIV to their babies, and in some cases, for their own health. Treatment plans should include AZT/ZDV (zidovudine or Retrovir) when possible to lower the risk of passing HIV to your baby.

If you haven't used any HIV drugs before pregnancy and are in your first trimester, you may want to wait until after the first trimester to start any HIV treatment. Since you may have nausea and vomiting early in your pregnancy, it may be hard to start the HIV drugs. Also, many vital organs and systems are formed during the first trimester, and we don’t know the effects some drugs have on a developing baby. Generally, women who need treatment should not wait to start, however. Keep in mind that HIV is usually passed to a baby late in pregnancy or during delivery. Talk to your doctor about your health status and the benefits and risks of delaying treatment.

If you are already taking HIV drugs and find out you're pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Weighing the known and potential benefits and risks will help you decide whether to continue or stop HIV treatment in the first trimester. Unfortunately, researchers don't know if stopping your HIV drugs causes problems with your baby. Stopping HIV drugs could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could progress and cause problems for your baby. For these reasons, many doctors think stopping HIV drugs is not a good idea. On the other hand, the effects of some HIV drugs on an unborn baby are not yet known, so it's a big decision. If you decide to stop, all of the drugs should be stopped at the same time and then started again (later in the pregnancy) together at the same time. This will prevent drug resistance (drugs that don't work anymore). When you do start taking HIV drugs again during the pregnancy, talk to your doctor about including AZT/ZDV in your treatment plan.

If you are already taking HIV drugs and find out you're pregnant after the first trimester, continue with treatment. Ask your doctor about including AZT/ZDV in your treatment plan.

During your pregnancy, your doctor may need to adjust your medicines. Changing your treatment will depend on many factors:

• Your CD4 count
• Risk of disease progression
• Use of HIV/AIDS drugs
• How far along the pregnancy is
• What is known and not know about the effects of the drugs on the fetus
• Best treatment for the health of the HIV-positive mother

There are certain drugs available in the United States that should not be taken by pregnant women because they may cause birth defects or harm the mother:

• Delavirdine (Rescriptor)
• Efavirenz (Sustiva)
• Combination of stavudine (d4T or Zerit)/didanosine (ddI or Videx)
• Hydroxyurea (anticancer drug) during the first trimester

Short-term use of nevirapine (Viramune) can be part of a pregnant woman’s HIV treatment plan, but should be monitored closely. It should be used with caution in pregnant women who have never had HIV treatment and who have CD4 counts greater than 250.

Protease inhibitors (PIs) are associated with higher levels of blood sugar and diabetes. Pregnancy is also a risk for high blood sugar. But we don’t know if PI use increases the risk of pregnancy-related diabetes.

Use of nucleoside reverse transcriptase inhibitors (NRTIs) can lead to a buildup of lactic acid in the blood, which can cause problems for pregnant women and developing babies. So, doctors need to monitor pregnant women using NRTIs. There is also some concern whether tenofovir and abacavir could affect bone health of the unborn baby.

For some HIV drugs, we don’t know enough about them to recommend use during pregnancy. These include entry inhibitors and integrase inhibitors.

No one can tell you for sure if your baby will be born with HIV. You can help lower your baby's HIV risk and keep yourself healthy by getting regular prenatal care and closely following your HIV drug treatment plan. See the Treatment section for more information on HIV medicines.