Perinatal HIV

Many people with human immunodeficiency virus (HIV) are able to have healthy pregnancies and deliver healthy babies. However, if you have HIV, there is a risk that you can pass the virus on to your baby anytime during pregnancy, labor and delivery, and breastfeeding.

The chances of passing the infection on to your baby are lower if you take HIV medicines, also called antiretroviral therapy (ART). ART medicines do not cure HIV, but they can keep HIV from spreading to your baby.

How does this affect me?

• Will need testing and medicines to help control the virus during pregnancy.
• Are more likely to need a cesarean delivery (C-section). This usually happens at 38 weeks of pregnancy.
• May not be able to breastfeed after the baby is born.

How does this affect my baby?

During pregnancy

• You are more likely to transmit HIV to your baby if:
  • You smoke or use drugs.
  • You have a vitamin A deficiency or other nutrient deficiency that affects the body's defense system (immune system).
  • You have another sexually transmitted infection (STI).
  • You do not treat HIV during pregnancy.
  • You have high amounts of HIV virus in your blood (high viral load).
• Perinatal HIV transmission is more common during labor and delivery.

After delivery

• May have side effects from ART medicines. These problems are minor, and they get better after birth.
• Will likely need ART medicines to help protect him or her from getting the virus. Your baby may need to take medicines within 6 hours of being born and up to 6 weeks after birth.
• May not be able to breastfeed. You may need to feed your baby formula instead.
• May need ongoing medical care and monitoring as he or she grows.

There is no way to guarantee that your baby will be born without HIV. Taking ART medicines and following your health care provider's instructions before and during pregnancy will help lower the risk of passing HIV to your baby.

What can I expect during labor and delivery?

• Your health care team will give you ART medicine through an IV a few hours before delivery.
• If you have a low viral load, you may be able to have a vaginal delivery.
• If you have a high viral load, you will receive extra care and deliver your baby by scheduled cesarean delivery.
• You will continue to take your ART medicines on schedule as much as possible.

Follow these instructions at home:

Medicines

• Take your ART medicines exactly as told by your health care provider. This is the most important thing you can do for your health and your baby's health.
• To fully protect you and your baby, your health care provider will:
  • Start you on ART treatment if you are not already on medicine.
  • Keep you on your current ART treatment if you are already taking medicine.
  • Make some changes to your ART treatment to make sure you are getting the best possible treatment.
• Keep taking your ART medicines after your baby is born.
• Take over-the-counter and prescription medicines only as told by your health care provider. This may be needed to treat infections or side effects of ART.

Eating and drinking

• Eat a balanced diet that includes fruits and vegetables, whole grains, lean protein, and dairy.
• Do not drink alcohol.
• Take a prenatal multivitamin that has 400 mcg of folic acid.

Feeding your baby

• Depending on where you live, breastfeeding may not be recommended due to the risk of passing the virus on to your baby through your breast milk. Talk with your health care provider about the risks and benefits of breastfeeding. Your health care provider will help you make a decision that is right for you.
• If you choose not to breastfeed, talk with your health care provider about your options. These may include bottle-feeding your baby infant formula or donated breast milk from a human milk bank.

Caring for your baby

• Start medical care for your baby right after birth. Your baby's health care provider should see your baby shortly after birth and regularly during the first year.
• Give your baby all of his or her ART medicines as told by the health care provider. This is very important.
• Make sure that your baby gets tested for HIV according to your health care provider's instructions. Your baby may be tested on a schedule at different ages. For example, your baby may be tested at:
  • 2–3 weeks old.
  • 1–2 months old.
  • 4–6 months old.
  • 18 months old if the first three tests are negative.

General instructions

• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Do not use drugs.
• Keep all follow-up visits. This is important. Regular visits may be planned for both you and your baby.

Contact a health care provider if:

• You are having trouble stopping your use of tobacco, alcohol, or other drugs.
• You have concerns about your viral load.
• You are not able to take your ART medicines.

Summary

• Many pregnant individuals with HIV are able to have healthy pregnancies and deliver healthy babies.
• Take your ART medicines exactly as told by your health care provider. This is the most important thing you can do to lower your baby's risk for HIV.
• Make sure your baby gets ART medicines as told by your health care provider. Your baby should also get tested for HIV according to your health care provider's instructions.
• Keep all follow-up visits for yourself and your baby. This is important.