Medically tested by Emily Barr, PhD, RN, CPNP-PC, CNM, ACRN, FACNM, FAAN
It can feel overwhelming if you are living with human immunodeficiency virus (HIV) and want to get pregnant. You may wonder if you could pass the virus to your baby or if you can continue taking your HIV medication while you are pregnant. These concerns are valid.
But many women living with HIV can and do go on to give birth to a healthy baby. Every year, 3,500 people living with HIV in the United States give birth.
We’re here to provide some answers that may put you at ease and help you talk with your healthcare provider.
Can I get pregnant if I have HIV?
Yes, you can. But it is ideal to talk with you HIV specialist before you get pregnant. This can help make sure you are healthier before you get pregnant, allow for any adjustments to your medication, and help you not pass HIV to your baby.
Of course, surprise pregnancies can happen, so if you find out you’re pregnant, tell your healthcare provider as soon as possible.
As long as you take HIV medication and your viral load remains undetectable, your chances of passing HIV to your baby may be less than 1%. A undetectable viral load means that the amount of HIV in your blood is so low that a lab test cannot detect the virus.
Pregnancy at age 35 and older (called advanced maternal age or geriatric pregnancy) carries certain health risks compared to people under 35, regardless of your HIV status, including:
The research is limited to those living with HIV who are pregnant over the age of 35, but there are likely to be higher risks.
Can I continue HIV medication while pregnant?
Yes, you can and, in fact, you should. It is important to take HIV medication while you are pregnant to protect both your health and the health of your baby. This can significantly reduce the chances of passing HIV to your baby.
Do not skip doses and taking your medicine at the same time every day to keep your viral load as low as possible.
Many of the HIV drugs are believed to be safe to take when you are pregnant. But depending on what you’re taking and how far along you are in your pregnancy, your healthcare provider may suggest that you change some of the HIV medications you’re currently taking if you become pregnant. It’s important to talk to your healthcare provider about the pros and cons of potential medications.
What are the risks to the baby if I live with HIV?
Most babies who become infected with HIV acquire the virus at birth. If you have a vaginal delivery, your healthcare provider can give you medication through an IV line that can reduce the chances of passing the virus to your baby. If you viral load is highyou may have a caesarean section and receive intravenous medication. This can help reduce the risk of transmission.
HIV can also cross the placenta and infect the baby in the womb. However, if you continue to take your HIV medicines as directed during pregnancy, labor and delivery and give your baby HIV medicines for two to six weeks after they are born, your baby has less than 1% chance of becoming infected with HIV.
Studies have shown that women living with HIV are up to two to three times more likely to have pregnancy complications from HIV-negative women. These complications can occur even if HIV-positive women are receiving antiretroviral therapy (ART). Possible complications include:
- Miscarriage or stillbirth
- Having a baby born with a low birth weight
- Premature or very premature birth
Can I breastfeed if I have HIV?
You can choose to feed your baby your milk by breastfeeding, nursing or pumping with a greater than 99% chance of not transmitting HIV if you are taking medicines for HIV and your viral load is undetectable. The pros and cons should be discussed with key family members and your HIV specialist to make the best decision for you and your baby.
If you are in ART, the World Health Organization Breastfeeding guidelines are the same as for people not living with HIV.
Can I take PrEP while pregnant or breastfeeding?
It is safe to take PrEP (pre-exposure prophylaxis) while you are pregnant or breastfeeding to prevent the transmission of HIV. PrEP is safer when taken as a daily pill because PrEP injections are not approved in pregnancy.
PrEP is taken by people who do not have HIV but are at high risk. You may want to take PrEP if you have a partner who is living with HIV, has or has had unprotected sex, or shares or shares needles while injecting drugs.
If your partner has HIV, it’s also a good idea to get tested often because the risk of passing the virus to your baby is higher if you get the virus during pregnancy or while breastfeeding.
Will I be considered a high-risk pregnancy and need more doctor appointments?
Yes, your pregnancy will be considered high risk because living with HIV can put you in a difficult position increased chance of pregnancy complicationssuch as miscarriage, stillbirth and low birth weight. And you’ll have more appointments because you’ll have to see your HIV team as well as your OB team. Your health care team, including your HIV specialists and your OB or midwife, will want to monitor you more closely to plan a healthy birth and avoid complications. They will check routine prenatal labs such as kidney and liver health, iron levels, blood sugar, and also how well the HIV medications are working.
They may also be offered to you certain vaccinations such as influenza, Tdap, RSV, Covid-19, pneumococcal and hepatitis A and B if needed.
We have come a long way and it is not only possible but possible that your baby will be born HIV free. Talk to your healthcare team about how you can have the healthiest pregnancy possible while living with HIV.
This educational resource was created with the support of Merck.
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