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What to Expect: HIV and Pregnancy

If you know METRO, you know one of the many services we offer is HIV care. From HIV testing to PrEP, to case management and more, we make sure those with HIV who walk through our doors are well taken care of.

One aspect of HIV care we don’t often talk about is what it looks like when you’re pregnant. So, what happens if you’re expecting a bundle of joy and you’re living with HIV? Let’s talk about it.

How Do You Get HIV?

First and foremost, we need to talk about how somebody can get HIV. The only way a person can get HIV is by coming into direct contact with certain body fluids from a person living with HIV that has a detectable viral load.

These body fluids are:

  • Blood
  • Semen (cum) and pre-seminal fluid (pre-cum)
  • Rectal fluids
  • Vaginal fluids
  • Breast milk

This means HIV can only be spread through specific activities. In this US, the most commons way are having vaginal or anal sex or sharing injection drug equipment like needles with somebody who has HIV.

Less common ways include from mother to child during pregnancy, birth, or breastfeeding. This brings us to today’s topic: How does living with HIV during pregnancy affect you and the child?

Before, During, and After Pregnancy

Before Pregnancy

If you have HIV and are considering becoming pregnant, it’s recommended you talk to an OBGYN. In an ideal situation, you will be taking HIV medications and have an undetectable viral load before trying to have a baby. 

Most medications are safe during pregnancy and most people don’t need to switch medications while pregnant, but this should always be discussed with your doctor. 

By doing this, you will have a better chance of an undetectable load and will have a much lower risk of passing HIV to your baby. 

During Pregnancy

Two things to keep in mind during pregnancy are medication adherence and monitoring during pregnancy. We can’t stress enough how important it is to follow your treatment plan as directed. The plan you and your doctor create is meant to help you, and ensure the health of you and your child.

While in labor, the type of medications administered to you is directly related to the amount of HIV in your blood. If it’s above a certain level, your doctor may recommend administering Zidovudine through an IV. Zidovudine helps reduce the risk of HIV transmission. This in combination with HIV medications, if you’ve taken them as prescribed during labor or before a C-Section, provides maximum protection to you and your baby.

Delivery methods also vary in safety depending on your HIV viral load. In general, a vaginal delivery is the go-to if the risk of transmission is low and there’s no other reason to have a C-Section. However, if your viral load is high, a C-Section may be recommended. 

Postpartum Care and Considerations

Once you have delivered your baby, it’s important to continue caring for yourself while caring for the baby. You should continue taking your HIV medications. Your doctors and case manager, if you have one, can also help make sure you have the support and care you need. 

This includes screening for postpartum depression, help with medication adherence, family planning, and birth control.

It’s important to note that it is possible to pass HIV to your baby through breastfeeding. Clean water and baby formulas are a safe alternative to breastfeeding. The Public Health Service recommends people with HIV not breastfeed their babies, even if they’re on medication.

It’s also not uncommon for babies born to mothers* with HIV to be treated with medications during the first two months. This can help prevent the baby from getting HIV since it was exposed to the mother’s* blood during delivery.

The baby will also most likely get HIV “antibody testing” to find out if the baby has HIV. These tests aren’t foolproof in young babies, though. This is because HIV antibodies may transfer from mother* to baby, which can result in a positive test while the baby may not necessarily have HIV.

What if my baby contracts HIV during delivery?

If you took all your medications as directed while pregnant, the chance of your baby having HIV is very low. If your child does have HIV, the best thing to do is not to panic. Your child can live a healthy life with the right treatment, just like you can! 

Local Resources for Parents-to-Be

Pregnancy is different for everyone, but no one should do it alone. From free pregnancy tests and baby showers, to HIV prevention and more, TOPWA program specialists are here to support soon-to-be parents in Pinellas and Hillsborough counties.

* Not all people who give birth would identify themselves as mothers, including transgender parents, surrogates, and more. It’s important that providers and caregivers do not make assumptions based on someone’s ability to carry a child.

Sources: UpToDate