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Pregnancy
& HIV
Treatment & Pregnancy
Delivery options
Drug Interactions
I want to have
a baby. Can I get pregnant?
Lots of HIV-positive woman and men
are amazing parents. Whether you are
HIV positive or not, parenting takes
a lot of work and energy. But it can
be the most fun and fulfilling thing
you do.
“The only thing I have to
make sure I do is keep myself healthy.
But being a mom gives me a lot of
reason to stay healthy!”
HIV can be passed on to your baby:
- before birth, in the uterus
- during the birth process
- after birth, through breastfeeding
New Canadian guidelines now reduce
the risk of passing HIV on to your
child.
Surprise! I’m
pregnant
Maybe you have just found out
that you are pregnant but know that
this is not a time in your life when
you can carry on with it. You may
want to look into all the options
and get more information about pregnancy,
abortion and adoption.
“I found out I was pregnant
and HIV positive at the same time.
It was scary not knowing what to do.”
Since I have
HIV is it harder to get pregnant?
Research shows that HIV-positive
women may find it harder to get pregnant
than HIV-negative women. But more research
is needed in this area. Some HIV-positive
women who want to get pregnant use artificial
insemination. By doing this their partner
does not expose himself to the HIV virus.
Artificial Insemination is a procedure
where a person puts sperm into a woman’s
womb by using a syringe. It can usually
be done at home, but you should talk
to your doctor to get all the information
first.
Here are some things that will help
you reduce the risk of passing HIV on
to your baby:
- Lower your viral load by taking
anti-retroviral therapy during pregnancy.
- Give your baby a short course
of anti-retroviral therapy after
birth.
- Do not breastfeed.
Remember: When you are trying
to figure out all the details about
delivery you need to talk with your
health care provider.
“I think of how much risk I
am putting my HIV-negative partner
at by trying to get pregnant. Doctors
are not well prepared to help HIV-positive
women through the emotional part of
this.”
“I ruled out artificial insemination
because of the cost, but it is an
option.”
What if my partner
is HIV positive, too?
If you and your partner are both
HIV positive, you should talk about
the risk of re-infection with your
health care provider.
I’m an HIV-positive
male and I want to father a child,
will my baby get HIV?
If you are an HIV-positive male and
you want to have a child with an HIV-negative
woman, the risk is that the woman
will get HIV. If she gets HIV and
gets pregnant, then the baby is put
at risk of getting HIV, too. If the
male’s viral load is at an undetectable
level it is harder to pass HIV on,
but it is not impossible to do so.
Talk to your doctor about your options.
How will pregnancy
affect my health?
Like always, keep eating a balanced
diet and living a healthy life. Being
pregnant is not a health risk for
you as an HIV-positive woman. Pregnancy
does not affect HIV, and HIV does
not impact the pregnancy. But, if
you are pregnant you should take anti-retroviral
therapy for your own health, as well
as to prevent passing HIV on to your
baby. Your therapy should be carefully
chosen, so talk to your doctor about
what you and your baby need.
“I think getting support from
a good doctor and a support group
is important for any HIV-positive
pregnant woman.”
Another really important thing to
staying healthy is to get good prenatal
care. Try to find an obstetrician
(OB) who is familiar with HIV care.
It is best to do this before you get
pregnant or soon after.
Other things you can think about
are:
- finding a health care provider
who screens and treats you for sexually
transmitted infections (STIs)
- giving up smoking, drinking, and/or
recreational drugs. If you really
are struggling to do this, talk
to your doctor or health care professional
about how you can cut back on these
things.
- reducing your stress
- putting together or joining a
support network
Treatment & Pregnancy
What drugs are
recommended to take while I am pregnant?
In Canada it is recommended that
all pregnant, HIV-positive women take
combination anti-retroviral therapy
regardless of their CD4 count or viral
load. It is also recommended that
intravenous AZT (Zidovudine) therapy
is given to the mother during labour.
A single oral dose of nevirapine (Viramune)
is also sometimes recommended.
Which meds you take depends on a
lot of things, including the HIV drugs
you have taken in the past and what
is available. Certain drugs can cause
side effects in pregnancy and should
be avoided. These include Sustiva,
(efavirenz), liquid amprenavir (Agenerase),
delavirdine (Rescriptor) and the combination
of ddl (Videx) and d4T (Zerit).. Check
with your health care provider for
up-to-date information.
Also, ask your local ASO or healthcare
provider about free prenatal vitamins.
[Check out Getting
Help]
When can I
start anti-retroviral therapy?
Your health care provider will probably
recommend starting therapy in the
second trimester, after 12-14 weeks
of pregnancy-unless there is a medical
reason to start earlier, such as a
very high viral load. The main reason
for waiting is that the anti-retroviral
drugs could have negative effect on
your baby in the early stages of its
development.
Monthly tests should be done to monitor
the side effects of therapy, including
hyperglycemia, anemia and kidney and
liver toxicity. Viral load and CD4
counts should be taken at the beginning
of your pregnancy and then every 4-6
weeks during pregnancy.
What I’m
already on anti-retroviral therapy!
If you are pregnant and you are already
on anti-retroviral therapy, you and
your health care provider may decide
to change your meds. Some drugs are
better than others when you’re
pregnant. Others can cause serious
harm to you and your baby. Talk to
your health care provider as soon
as possible about the best choices
for you.
“Since I tested positive I have
been thinking about becoming pregnant.
I have now been on meds for over a
year and if I choose to get pregnant
I might have to change my meds.”
It is not a good idea to come off
or change your therapy without seeing
your health care provider. If you
stop your treatment suddenly, your
viral load may rebound and there may
be an increased risk of passing HIV
on to your baby. You may also develop
drug resistance. This means that the
HIV meds you are on could stop working
on you and would limit your options
in the future.
What can I
do if I don’t want to take anti-retroviral
medication (HIV meds)?
Even though it is strongly recommended
that you take meds during pregnancy,
it is ultimately your choice. If meds
are only given during labour and delivery
you can still reduce some of the risk
of passing HIV on to your child.
If you don’t take any meds before
you give birth there is some treatment
given to newborns at birth that may
lower the risk of passing HIV on to
babies.
Does my child
have to take treatment?
In Canada, it is recommend that if
the mother did not receive anti-retroviral
therapy during pregnancy or delivery,
zidovudine and nevirapine therapy
should be given to the baby as soon
as possible after birth.
If the mother received anti-retroviral
therapy, zidovudine is given to the
baby within 6-12 hours after delivery
and is continued for six weeks.
While your baby is developing inside
of you, you have the right to choose
whether you take anti-retroviral therapy.
Once your child is born, Child Welfare
may intervene to make sure your child
gets anti-retroviral treatment if
they believe it is in the best interest
of the child.
How will the
medication affect my child?
There still isn’t that much
research that looks at the long-term
effects of the medications on HIV-positive
children.
“My child is HIV positive. What
will her health be like in the future?”
Very few HIV meds have been thoroughly
studied for use in pregnancy. Short-term
side effects of these drugs are generally
limited to mild anemia, but there
is not a lot know about the long-term
effects. If you are planning to become
pregnant, do not use Sustiva (efavirenz)
as one of the drugs in your combination.
If you become pregnant while you are
taking Sustiva, talk to your doctor
about switching to another drug as
soon as possible.
Can I still
use drugs or alcohol when I’m
pregnant?
You need to talk to your health care
professional about this question.
It is recommended that you stop using
drugs or alcohol when you are pregnant
because alcohol and drug use can permanently
harm your baby. You also have a higher
chance having a still-born birth—this
means the baby died inside of you.
If you are really struggling to stop
using alcohol and drugs talk to your
doctor or healthcare professional
about your options.
Delivery options
What are my delivery
options?
There are two types of delivery:
- Caesarian section (C-section)
- vaginal delivery
If your viral load is less than 1,000,
both a C-section or vaginal birth
are possibilities and have relatively
low risk associated with them. If
your viral load is over 1,000 or you
are not on treatment at the time of
your delivery, an elective C-section
may be the best way to reduce the
chances of passing HIV on to your
baby. It is your choice whether you
have a C-section.
“As for the C-section, I found
it so strange and weird. But now that
I think about it, it was just a moment
of discomfort leading to a long, wonderful
life with my beautiful boy.”
To further reduce the risk of passing
HIV on to your child during delivery,
it is recommended that you try to
avoid:
- the unnecessary rupture of the
membranes
- the use of fetal scalp electrodes
and fetal scalp sampling
- the use of forceps or vacuum
Can I breastfeed
my baby?
Since a baby can get HIV through
breast milk, it is important not to
breastfeed. You may need extra support,
especially if breastfeeding is an
expectation of family, friends and
the community in which you live. In
most provinces, you can get FREE formula
through government programs. Talk
to you doctor about the programs near
you that give out formula or check
out the Getting
Help section for other organizations
that can direct you.
How will I
know if my baby is HIV-positive?
All babies born to mothers with HIV
are born with HIV antibodies. This
means that they may test positive,
because you are HIV positive. But
there is a technology called PCR that
lets you find out pretty quickly the
status of your baby. PCR looks for
the virus itself and not antibodies—like
the traditional HIV antibody test.
What if my
baby is infected with HIV?
Many HIV-positive children lead healthy,
active lives. The biggest thing to
be involved in is your child's treatment.
It is important that your child be
seeing a doctor who specializes in
HIV on a regular basis and stays on
the meds that the doctor recommends.
There are lots of supportive programs
and people out there who can help
you. Like any parent, you will have
to make decisions about your baby’s
health. But you will need to keep
in mind your own health as well. This
can be stressful, so it is important
to build a strong support network
of knowledgeable health care providers,
social and community services, as
well as emotional and practical support.
“I would have liked to have
known how to support my HIV-positive
child. I wasn’t prepared for
the endless blood work and the medication
he would have to take while growing
up.”
Drug Interactions
What about methadone
and pregnancy?
“I am a former addict. When
I was pregnant, everyone put their
moral judgments on my life about whether
I should even be allowed to have children.
Moral judgments prevent women from
getting the chance to learn healthy
baby and self-care skills.”
Studies have shown that there is
no increased risk of birth defects
or developmental difficulties in babies
who were born to methadone-treated
women. It is important that you realize
that your baby may be dependent on
(addicted to) methadone at first and
need to be weaned off. If you are
on methadone and get pregnant, you
should not stop your methadone treatment
without first talking to your health
care provider.
I have Hepatitis
C (HCV). Can I infect my child?
HIV increases risk for passing hepatitis
C on to your child. So, if you don’t
have HIV, there is a lower risk of
passing hepatitis C on to your child.
Right now, there is no known way to
stop the mom from passing hepatitis
C on to her child. It is also important
to know that ribavirin, a drug commonly
used to treat hep C, can cause severe
birth defects. Women should not use
it for at least six months before
they become pregnant or during pregnancy.
The same goes for men! Male partners
should not use ribavirin for at least
six months before they decide with
their partner to get pregnant.
Information based
from the "Pregnancy & HIV:
Life goes on…" pamphlet
Published by Voices for Positive
Women (Toronto, Ontario)
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