I'm HIV positive. What do I need to know before I get pregnant?

I'm HIV positive. What do I need to know before I get pregnant?

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Is it safe to have a baby if I'm HIV positive?

It's entirely possible for a woman with human immunodeficiency virus (HIV) to have a healthy baby. If you follow your healthcare provider's advice before you conceive, throughout pregnancy, and after delivery, the risk of passing HIV to your baby is about 1 percent or less.

HIV is transmitted through bodily fluids including blood, vaginal fluids, and breast milk, so there's a chance of passing the virus on to your baby during pregnancy, labor and delivery, or when breastfeeding. However, the number of babies infected this way has declined significantly since the early 1990s due to advances in HIV research, prevention, screening, and early treatment.

Do I need to see my doctor before trying to conceive?

Yes. Talk to your healthcare provider before becoming pregnant. There's a lot you can do to have a healthy pregnancy and reduce the risk of passing on the infection to your partner and baby. Taking the right medications before and during pregnancy reduces the risk of viral transmission to the baby.

If you're on antiretroviral therapy (ART), you may need to change your drug regimen before conception. Not all ART drugs are safe to take during pregnancy, so work out a plan with your provider.

For example, the drug efavirenz is linked to birth defects in babies when it's taken early in pregnancy, so a provider will only recommend it in the first trimester if there's no other alternative. It's dangerous to stop taking medication suddenly, so talk with your provider first.

Once your provider reviews your ART regimen and gives you the go-ahead to get pregnant, follow the regimen carefully. Forgetting to take medication, or taking it at the wrong time, puts you at risk of increasing the level of HIV in your body or having the drug mutate into a drug-resistant strain of HIV that's difficult to treat.

The goal of treatment before pregnancy is to lower the virus to an undetectable level before conception. This is determined by a blood test that measures the viral load in copies per milliliter (copies/mL). If it's below a certain level (usually between 40 and 75 copies/mL), it's considered undetectable.

Once on ART, it's possible to have an undetectable viral load within six months.

Besides taking HIV medication, how do I prepare for pregnancy?

Ask your provider to help you to improve your pre-pregnancy health:

  • Take folic acid. All pregnant women need a daily vitamin supplement that contains 400 micrograms (mcg) of folic acid daily, starting at least a month before getting pregnant. Folic acid prevents defects of the brain and spine in babies.
  • Get vaccinated. Important pre-pregnancy immunizations include vaccinations for hepatitis A, hepatitis B, pneumococcus, and influenza.
  • Stop smoking, drinking alcohol, or abusing drugs. If needed, your provider can help you get treatment.
  • Practice safe sex. Condoms can prevent sexually transmitted infections (STIs) and protect your partner from HIV.

Can I get pregnant without putting my partner at risk?

Yes, you can. But it's necessary to take precautions because there's a risk your partner could contract the virus through unprotected sex.

Artificial insemination is the safest way to conceive. This can be done at home with a syringe when you ovulate, though you'll need to keep track of your cycle so you know when you're most fertile.

Some couples want to conceive naturally. If you choose to do this, minimize the risk of HIV infection by taking ART and waiting until your viral load is undetectable. In addition, your provider may recommend a form of ART to your partner called pre-exposure prophylaxis (or PrEP). Then time unprotected sex with the most fertile days in your cycle.

Will I have trouble conceiving?

No one knows for sure if HIV causes fertility problems. Some studies report fertility problems in HIV-positive women. Other studies have found that being HIV positive doesn't make a difference.

It could be that another condition associated with HIV causes a fertility problem. For example, if you are HIV positive, you're at higher risk of other sexually transmitted infections (STIs), which sometimes make conception more difficult.

If you haven't already been tested for other STIs, see your provider. As with all moms-to-be, it's important to avoid STIs during pregnancy, so use condoms during sex.

Ask your provider to refer you to a fertility specialist with experience treating people with HIV if you're struggling to conceive.

Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.


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