Nlm.nih.gov. An HIV positive woman can transmit the virus to her baby during pregnancy, labour and delivery, and through breastfeeding. If she takes no preventive drugs and breastfeeds then the chance of her baby becoming infected is around 20-45%.
Modern drugs are highly effective at preventing HIV transmission during pregnancy, labour and delivery. When combined with other interventions, including formula feeding, a complete course of treatment can cut the risk of transmission to below 2%. Even where resources are limited, a single dose of medicine given to mother and baby can cut the risk in half.
Advantages of a planned pregnancy
A woman who knows that she or her partner is HIV positive before she becomes pregnant is better able to plan ahead. If she does not want to have a child then she should consider effective contraception. If she decides to become pregnant then early interventions may be able to help protect her, her partner and her baby. Doctors will be able to advise which interventions are best suited to her situation, and whether she should adjust any treatment she is already receiving.
Pregnancy does not make a woman's own health worse in respect of HIV. Being pregnant may cause her CD4 count to drop slightly, but it should return to its pre-pregnancy level soon after her baby is born.
Protection at conception
An HIV positive woman with an HIV negative partner can become pregnant without endangering her partner, by using artificial insemination (the process by which sperm is placed into a female's genital tract using artificial means rather than by natural sexual intercourse). This simple technique provides total protection for the man, but does nothing to reduce the risk of HIV transmission to the baby.
If the man has HIV then the only effective way to prevent transmission is sperm washing. This involves separating sperm cells from seminal fluid, and then testing these for HIV before artificial insemination or in vitro fertilisation. Sperm washing is a very effective way to protect both the mother and her baby, but it is only available at a few clinics and can be difficult to access, even in well resourced countries.
When both partners are HIV positive, it might still be sensible for them not to engage in frequent unprotected sex, because there might be a small risk of one re-infecting the other with a different strain of HIV.
If a couple do decide to try conceiving a child by unprotected sex then they should seek advice on how to limit the risk to each other and to their baby. It is worth noting that someone is less likely to transmit HIV if they are receiving effective antiretroviral treatment, and also if neither they nor their partner has any other sexually transmitted infections. In addition, by limiting unprotected sex to the time of ovulation, a couple can reduce the number of opportunities for HIV to be transmitted between them.
What drugs should I take and when should I take them?
The drugs that can prevent HIV being passed from a mother to her baby are called antiretroviral (ARV) drugs. ARVs are the drugs that are also taken by HIV positive women who are not pregnant, to prevent them from becoming ill.
The most important time for an HIV positive pregnant woman to take ARVs to prevent her baby becoming infected is during labour. Depending on your particular circumstances it may be suggested that you take ARVs at other times as well.
Deciding exactly which ARVs to take and when to take them can be quite difficult, because there is a need to balance a number of different things, including:
- Your health as an HIV positive pregnant woman
- Reducing the risk of HIV being passed from you to your baby
- The possibility of developing ARV side effects
- The possibility of drugs causing harm to your baby.
There may also be a difference between which drugs you would ideally take and which ones it is actually possible for you to take, as there is considerable variation worldwide in the cost of ARVs and their availability.