According to the March of Dimes, there are an estimated 120,000 to 160,000 women in the United States who have been infected with HIV. About 6,000 to 7,000 of women infected with HIV give birth annually. Since the beginning of the HIV/AIDS epidemic, approximately 15,000 children in the United States have been infected with HIV and 3,000 children have died. About 90 percent of those were infected with the virus during pregnancy or birth.
HIV transmission from mother to child during pregnancy, labor, delivery or breastfeeding is called perinatal transmission. Perinatal HIV transmission is the most common way children are infected with HIV.
What is HIV/AIDS?
HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (Acquired Immunodeficiency Syndrome). A person may be “HIV positive” but not have AIDS. An HIV infected person may not develop AIDS for 10 years or longer. A person who is HIV positive can transmit the virus to others when infected blood, semen or vaginal fluids come in contact with broken skin or mucus membranes.
An AIDS infected person cannot fight off diseases as they would normally and are more susceptible to infections, certain cancers and other health problems that can be life-threatening or fatal.
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. According to the March of Dimes, new treatments can reduce the risk of a treated mother passing HIV to her baby to a 2 percent or less chance.
Factors which increase the risk of transmission include:
- Substance abuse
- Vitamin A deficiency
- 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
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. The March of Dimes recommends 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 counseling 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.
A woman’s health care provider may offer testing and counseling or may refer her to a local testing sight. Additional information about testing can be obtained from:
- National IV Testing Resources http://www.hivtest.org
- CDC-INFO 24 hours/day at 1-800-232-4636
- National Aids Hotline at 1-800-342-AIDS
The Food and Drug Administration has approved the Home Access HIV Test System. This testing system allows for confidential testing with the use of a home testing kit.
How can HIV/AIDS affect my 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 counseling 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-related 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.
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.
Compiled using information from the following sources:
AIDS Education & Training Centers National Resource Center, http://www.aids-ed.org
Centers for Disease Control and Prevention, http:// www.cdc.gov
March of Dimes, http://www.marchofdimes.com
Maternal & Neonatal Health, Mother-to-Child Transmission of HIV/AIDS: Reducing the Risks.
World Health Organization, http://www.who.int