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Pregnancy & HIV

Pregnancy & HIV
I want to have a baby. Can I get pregnant?
Surprise! … I’m pregnant
Since I have HIV is it harder to get pregnant?
What if my partner is HIV positive too?
I’m an HIV-positive male and I want to father a child, will my baby get HIV?
How will pregnancy affect my health?

Treatment & Pregnancy
What drugs are recommended to take while I am pregnant?
When can I start anti-retroviral therapy?
I’m already on anti-retroviral therapy!
What can I do if I don’t want to take anti-retroviral medication (HIV meds)?
Does my child have to take treatment?
How will the medication affect my child?
Can I still use drugs or alcohol when I’m pregnant?

Delivery options
What are my delivery options?
Can I breast-feed my baby?
How will I know if my baby is HIV-positive?
What if my baby is infected with HIV?

Drug Interactions
What about methadone and pregnancy?
I have Hepatitis C (HCV). Can I infect my child?

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.

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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.”

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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.”

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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.

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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.

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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]

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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.

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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.

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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.

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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.

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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.

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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:

  1. Caesarian section (C-section)
  2. 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:

  1. the unnecessary rupture of the membranes
  2. the use of fetal scalp electrodes and fetal scalp sampling
  3. the use of forceps or vacuum

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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.

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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.

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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.”

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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.

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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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