HIV DURING PREGNANCY
What are the risk factors for transmitting HIV during pregnancy?
If a woman is infected with HIV, her risk of transmitting the virus to her baby is reduced if she
stays as healthy as possible.
A baby can become infected with HIV in the womb, during delivery or while breastfeeding. If
the mother does not receive treatment, 25 percent of babies born to women with HIV will be
infected by the virus. With treatment that percentage can be reduced to less than 2 percent.
Factors which increase the risk of transmission include:
 Smoking
 Substance abuse
 Vitamin A deficiency
 Malnutrition
 Infections such as STD’s
 Clinical stage of HIV, including viral load (quantity of HIV virus in the blood)
 Factors related to labor and childbirth
 Breastfeeding
Should pregnant women get tested for HIV? How is testing done?
Women who are planning on becoming pregnant or who are pregnant should be tested for HIV
as soon as possible. The woman’s partner should also be tested.
It is recommended that all women of childbearing age who may have been exposed to HIV
should be tested before becoming pregnant. Women who have not been tested before becoming
pregnant should be offered counselling and voluntary testing during pregnancy.
Women who have not been tested during pregnancy can be screened during labor and delivery
with rapid tests which can produce results in less than one hour. This allows for treatment to
protect the baby should the results be positive.
HIV/AIDS testing is conducted with a blood test.
How can HIV/AIDS affect pregnancy?
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 provide 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 with attention given to preventing iron or vitamin
deficiencies and weight loss as well as special interventions for sexually transmitted diseases or
other infections (such as malaria, urinary tract infections, tuberculosis or respiratory infections)
should be part of the prenatal care of HIV infected women.
Health care providers should watch for symptoms of AIDS and pregnancy 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.
How to handle prenatal care when HIV positive
A multi-care approach is the most effective way for pregnant women with HIV infection to have
a healthy pregnancy and delivery. This approach will address the medical, psychological, social
and practical challenges of pregnancy with HIV. While the woman’s pregnancy is being
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managed by a health care provider and HIV specialist, she may also receive assistance from a
social services agency to help her with housing, food, child care and parenting concerns.
She would also be receiving counselling support for herself and her partner. Additional care
could be provided in the areas of substance abuse and lifestyle counselling. This team effort will
provide the best prenatal care plan for women infected with HIV. Many of these services could
continue during her postpartum period.
Is there safe treatment for women during pregnancy?
It is recommended that HIV-infected pregnant women be offered a combination treatment with
HIV-fighting drugs to help protect her health and to help prevent the infection from passing to
the unborn baby.
Zidovudine (also known as ZDV, AZT and Retrovir®) was the first drug licensed to treat HIV.
Now it is used in combination with other anti-HIV drugs and is often used to prevent perinatal
transmission of HIV.
ZDV should be given to HIV-infected women beginning in the second trimester and continuing
throughout pregnancy, labor and delivery. Side effects include nausea, vomiting and low red or
white blood cell counts.
How does HIV affect labor and birth?
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 amniotomies (intentionally
rupturing the amniotic sac to induce labor), episiotomies 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.
Cesarean sections performed before labor 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 labor should be treated during labor
with one of several possible drug regimens. These may include a combination of ZDV and
another drug called 3TC or Nevirapine. Studies suggest that these treatments, even for short
durations, may help reduce the risk to the baby.
Will thebaby need treatment after delivery?
A 1994 study by the National Institutes of Health found that giving ZDV to an HIV-positive
pregnant woman during her pregnancy and to her baby (within 8-12 hours of birth) decreased
the risk of passing the infection on to the baby by 66%. The baby should be treated with ZDV for
the first six weeks of life. Eight percent of babies of women treated with ZDV became infected,
compared with 25 percent of babies of untreated women.
No significant side effects of the drug have been observed other than a mild anemia in some
infants that cleared up when the drug was stopped. Follow-up studies show that the HIVnegative treated babies continued to develop normally.
Can a mother breastfeed if HIV positive?
About 15% of newborns born to HIV-positive women will become infected if they breastfeed for
24 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.
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The Maternal & Neonatal Health Program supports the following guidelines for breastfeeding
by women infected with HIV:
A woman who is HIV-negative or does not know her HIV status should exclusively breastfeed
for six 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 six
months. The woman should also be advised regarding the changing risks to her baby during
that six months, preventative treatments and early treatment of mastitis and oral problems,
weaning plans and how to determine the appropriate time to switch to formula feeding.
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