What is the chance that my baby will become HIV positive?

A baby can become infected with HIV in the womb, during delivery or while breast-feeding. 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, according to the March of Dimes.

How will my prenatal care be handled differently if I am 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 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 counseling support for herself and her partner. Additional care could be provided in the areas of substance abuse and lifestyle counseling. 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?

The United States Public Health Service recommends 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 my 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 my baby 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 HIV-negative treated babies continued to develop normally.

Can I breastfeed if I am 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.

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 counseled 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.