×
A. HIV is a type of virus called a retrovirus that prevents the body’s immune system from working properly and makes it hard to fight off infections. If you have the virus, this is known as being HIV positive.
The virus can be passed from one person to another through the exchange of body fluids including blood, semen, vaginal fluids and breast milk.
You can pass the virus on to your baby through the placenta while you are pregnant, during the birth and through your breast milk. The care you will receive aims to reduce the risk of passing HIV on to your baby.
All women are offered a test for HIV early in pregnancy.
A. You will be offered specialist care and regular health checks. You would be cared for by a team of specialists that includes:
You and your baby will be monitored during your pregnancy, and this may include extra ultrasound scans.
The amount of virus (viral load) and antibodies to HIV (CD4) in your blood will be monitored, as will drug levels if you are on treatment.
A. If you are HIV positive, it is important to know whether you are immune to certain infections.
Like other pregnant women, you will be recommended to have tests in early pregnancy for hepatitis B, rubella (German measles) and syphilis. However, you will also be offered tests for hepatitis C, varicella zoster (chickenpox), measles and toxoplasmosis.
All pregnant women are offered the whooping cough vaccine. You will also be recommended to have vaccinations for hepatitis B (if you are not immune) and pneumococcus, and the flu vaccine (in the autumn/winter months). These are safe in pregnancy.
The vaccines for chickenpox, measles, mumps and rubella are not safe in pregnancy and therefore you will be offered them after your baby is born, if you are not immune.
If you are receiving treatment for HIV for your own health, you may be recommended to have antibiotics to reduce your chance of developing pneumonia.
You should be offered a swab for vaginal infections early in pregnancy and then again around the 28th week of your pregnancy. If the swab shows infection, you should be offered treatment to reduce the risk of passing on HIV to your baby.
A. If you are taking certain medications for HIV in early pregnancy, you may be advised to have a test for gestational diabetes (diabetes that is first diagnosed in pregnancy) between 24 and 28 weeks.
A. Yes.
You can greatly reduce the risk of passing on HIV to your baby if you:
A. Yes.
The drugs used to treat HIV infection are known as anti-retrovirals.
Sometimes three or more types are used together, which is known as highly active anti-retroviral therapy (HAART). Your doctors will offer you anti-retrovirals during your pregnancy and at the birth of your baby (if you are not taking them already) to help reduce the chance of passing the virus on to your baby. Anti-retroviral treatment may also be of benefit to your own health.
If you do not have anti-retroviral treatment, there is a much greater risk that you will pass on the virus to your baby.
A. For you: Anti-retroviral drugs are generally safe but they can sometimes have side effects, including stomach and digestive problems, diabetes, rashes, extreme tiredness, high temperature and breathlessness. It is important to tell your doctor or midwife if you experience any unusual symptoms while you are pregnant.
Anti-retroviral drugs can also sometimes cause liver problems. If you have started HAART in pregnancy, you should have regular blood tests to check that your liver is working normally. Some drugs may reduce the levels of iron in your blood (anaemia) and you may be advised to have iron supplements.
You are more likely to go into labour early if you are taking HAART.
For your baby: Anti-retroviral treatment itself does not appear to be harmful for babies. Not taking the medication is much more likely to be harmful for your baby, because the risk of passing HIV on to your baby will be much higher.
A. You will be recommended to take those drugs considered best for you. You will also be advised when you should start and stop taking them. You may be in one of the following circumstances:
A. Your team will discuss with you the best way to give birth. The treatment you are taking, your viral load and CD4 count at 36 weeks and previous pregnancies will be taken into account.
A sample of your blood should be taken at the time of the birth to check the amount of the virus in your blood.
A. If you are taking HAART, you should continue to take this as advised by your doctor.
You should be prescribed zidovudine through a drip, which will be started a few hours before your caesarean section. It should continue until your baby is born and the umbilical cord has been clamped.
Because you are likely to have your caesarean section before 39 weeks, you should be offered a course of two to four corticosteroid injections over a 48-hour period to lessen the chance of breathing problems for your baby.
If your contractions start before your planned caesarean section, you should come straight to hospital. The caesarean section will be done as soon as possible. Occasionally, labour may be too advanced and it may be safer for you and your baby to have a vaginal birth.
A. You should be given HAART treatment throughout your labour. The earlier in labour that your waters break, the higher the risk of passing HIV on to your baby.
You should be prescribed an infusion of zidovudine if your waters have broken or if you are known to have a very high viral load.
If you go past your due date and your viral load cannot be detected, it may be possible to have labour started off (induced).
A. The management will depend on the stage of pregnancy.
After 37 weeks
Before 37 weeks
If your waters break before your contractions start, your team will discuss with you whether it would be better for your baby to be born rather than waiting. This will depend on how far you are in your pregnancy and your individual risk of transmitting HIV to your baby.
A. Your baby should be given anti-retroviral drugs within 4 hours and this should be continued until he or she is between 4 and 6 weeks of age.
Your baby should be tested for HIV during the first 2 days, on discharge from hospital, at 6 weeks and at 12 weeks.
If these tests are negative and you are not breastfeeding, your baby does not have HIV.
A further test to confirm this will be done when your baby is 18 months old.
A. You can greatly reduce the risk of passing on HIV if you do not breastfeed and do not use your own expressed breast milk. This is the single most important means of reducing the risk to your baby.
If you are HIV positive, it is safer to use formula milk.
A. If either you or your partner is HIV positive, you should be advised about safer sex practices and the use of condoms to prevent transmission of HIV.
situation, sperm washing may not reduce the risk of transmitting HIV and may actually reduce the likelihood of getting pregnant
You may wish to consider assisted conception with sperm washing or donor sperm if there is a high chance of transmitting HIV.
A. If you are HIV positive, you should get contraceptive advice from the specialist team after you have had your baby.
Women with HIV infection are recommended to have yearly cervical