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Do HIV-positive women need to see a specialist during pregnancy?
Yes. It's important to find a specialist who has experience caring for pregnant women with HIV. There are also special perinatal clinics for HIV-positive women, where you can find a team of doctors, midwives, and other providers to care for you.
Ask the provider who currently treats and manages your HIV for a referral, or try calling your local health department or a major medical center near you to find out what resources are available. If you can't find a provider who specializes in treating HIV-positive pregnant women, at least make sure the person who cares for you during your pregnancy works very closely with the provider who treats and manages your HIV.
What will happen at my first prenatal visit?
Your provider will want to find out more about your medical history and any past HIV treatment you've had. He'll also want to get a clear picture of your health status right now. This information will help you get the care you need.
Along with the routine tests and checks that happen at a regular prenatal appointment, your provider will need to do some additional procedures.
Your provider will do blood tests to determine your viral load (the amount of the virus in your blood) and your CD4 cell count (the number of CD4 immune cells you have). If you're already being treated for HIV, you'll be familiar with these tests. They show how healthy your immune system is and whether the drugs you take are working.
The CD4 count also indicates whether you need antibiotics to prevent pneumonia or other infections.
Your provider may do tests to see what medications your strain of HIV is susceptible to, to check for anemia, and to see how well your liver and kidneys are functioning.
You may be at higher risk for other sexually transmitted infections (STIs), so your healthcare provider may test for these. You may also be tested for toxoplasmosis, hepatitis A, hepatitis B, hepatitis C, and tuberculosis.
Your provider will review your vaccinations to make sure they're current and offer you any you need, especially hepatitis A, hepatitis B, flu, and pneumococcus. Your provider may also suggest that you get the Tdap vaccine, which protects you from three serious diseases: tetanus, diphtheria, and pertussis (whooping cough).
Being immunized with Tdap during pregnancy means that your baby will share the antibodies you create, and have some protection against these diseases until she's old enough to be vaccinated herself.
Finally, your provider will help you coordinate any other care and support you need to help you have a healthy pregnancy. This might include help quitting smoking or dealing with a substance abuse issue. Your provider can also help you get mental health services if you're struggling with depression or anxiety.
What's the treatment for HIV during pregnancy?
Experts recommend that everyone with HIV receive antiretroviral therapy (ART). This is especially important during pregnancy.
ART works by suppressing the HIV virus, which protects your immune system to keep you healthy. It cuts the risk of your baby becoming HIV positive by reducing the amount of virus your baby is exposed to during pregnancy and delivery. Some ART drugs cross the placental barrier, so they offer your baby some direct protection as well.
Your exact treatment depends on your test results, your clinical condition, how far along your pregnancy is, and whether you're already taking antiretroviral medications. Your provider will discuss with you any potential effects a medication may have on your baby.
If you're already receiving ART when you discover you're pregnant, don't stop taking your drugs. Contact your healthcare provider immediately to make sure the drugs you're taking are the best ones during pregnancy. Your provider will also review your dose because this may need to change when you become pregnant.
If you're already on medication but can't keep it down because you're vomiting from morning sickness in the first trimester, your provider may give you an antinausea drug. If that doesn't help, your HIV treatment may be stopped temporarily. Taking the medication erratically can contribute to drug-resistant strains of the virus, so you'll need to restart ART as soon as you're able.
Sticking to your ART regimen as closely as you can is key to keeping your viral load low. If you're having trouble adhering to the exact drug regimen at any time during your pregnancy, be sure to let your provider know right away. You'll also need to continue taking your regular medication during labor.
What type of care will I get later in my pregnancy?
Your provider will use blood tests to measure your viral load and CD4 count to ensure treatment is working. You'll also be tested to see whether you're having a bad reaction to your medication. This might include testing your blood sugar levels, iron levels, or your kidney and liver function.
For the most part, you'll have the same prenatal care as women who aren't HIV positive. However, amniocentesis is one test that could be problematic.
This is an invasive test, which is sometimes used to diagnose chromosomal abnormalities. In this procedure, a needle is inserted through the abdominal wall to extract a small amount of fluid from the amniotic sac surrounding the baby.
There are no reports of babies becoming infected with HIV following amniocentesis among women receiving ART. But if your viral load is high, your provider may tell you that the risk of infection to your baby is higher.
What can I do to have a healthy pregnancy?
In addition to keeping all your prenatal appointments and closely following the drug regimen designed for you, it's important to take care of yourself in other ways. Like all pregnant women, eating well, exercising, and saying no to alcohol, illicit drugs, and smoking will help you have a healthy pregnancy.
There's a lot to stay on top of during pregnancy, especially if you're HIV positive. But there's also a lot of assistance available.
There are many ways to build your own support network. But if you can't get the help you need from friends and family, ask your provider about local groups, or look for one online. Talking to others who have been through a similar experience and understand how you're feeling can provide very valuable practical and emotional support.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.