By: Ann Avery, Infectious Disease Physician at Metrohealth Medical Center
Pregnancy is a challenging and exciting time for anyone, regardless of whether either of the parents are living with HIV.
It is common for pregnant couples impacted by HIV to worry about their baby’s HIV status. However, with modern HIV medicine, it is very possible for a woman living with HIV to have a healthy baby who doesn’t have HIV.
With this relief, parents-to-be can focus on adapting to the other lifestyle and body changes that pregnancy entails. Keep reading for useful information about pregnancy and HIV.
If a mom-to-be is living with HIV
HIV can be transmitted during pregnancy, labor, or delivery. For women living with HIV, the good news is that the chances of transmission are extremely low – like only 1% - if the mother is undetectable and seeing her HIV doctor and OB/GYN regularly, and if the baby is given medicine after birth.
If a dad-to-be is living with HIV
Babies CANNOT get HIV from their fathers. The important thing in this scenario is to keep the woman who is going to get pregnant healthy. Women wishing to get pregnant with a partner who is living with HIV should consult a physician first and, in some cases, consider taking PrEP. It is also recommended that the dad living with HIV is on treatment and undetectable for at least 6 months before to trying to conceive.
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Pregnancy basics
Women can discover they’re pregnant in a few different ways. Some clues that women experience are missed periods, feeling overly nauseous, or otherwise just feeling unlike their normal selves. Using an at-home pregnancy test is normally the first step to verifying a pregnancy. The results should be confirmed by a doctor.
The doctor will determine a "due date" when the baby is expected to be born. However, this date is just an estimation. Only about 5% of women actually give birth specifically on that day. Normally, women can give birth anywhere from 3 weeks before to 2 weeks after their due date.
Pregnancy is a nine-month journey that is broken into three trimesters. Each trimester is 13 weeks long and has its own unique hormonal and physiological changes.
The first trimester
A lot of women in their first trimester may not "look pregnant" yet, but it doesn’t mean that incredible things aren’t happening inside their bodies. The embryo is just beginning to form, and after 8 weeks it is called a fetus.
The placenta, a temporary organ attached to the wall of the uterus that provides the fetus with nutrients to grow is also starting to develop during these initial weeks. You may also experience an increased heart rate as the body increases blood supply to carry oxygen to the fetus.
The first trimester often comes with some unpleasant symptoms, too. They include:
- morning sickness
- nausea and vomiting (sometimes called morning sickness, but it can really happen any time of day)
- constipation
- excessive tiredness/ extreme fatigue
- headaches
- tender or swollen breasts
- moodiness
- light spotting or bleeding
- frequent urination
During the first trimester (or even before, if the pregnancy is planned), women should begin taking prenatal vitamins and start having regular checkups with a doctor. Some visits include ultrasounds and bloodwork. Part of a healthy pregnancy is also keeping up with any HIV treatments you might be on. Maintaining an undetectable viral load means there’s less than a 1% chance of a pregnant woman passing HIV onto their newborn child.
Starting the first trimester, women are encouraged to make some changes to their lifestyle to help the baby's development, if they aren't already doing so already:
- Having a healthy diet and avoiding fish with high mercury levels, raw meats or eggs, deli meats, and unpasteurized milk (including cheese products made with unpasteurized milk).
- Avoiding caffeine, alcohol, cigarettes, and drug use. For any prescription medications, check with your doctor to make sure they won't interfere with the pregnancy or affect your baby’s development.
- Lowering your stress levels
The second trimester
Many people consider the second trimester the “comfortable period” because often many of the unpleasant first trimester symptoms go away. During this time, the woman’s breasts will start to grow to prepare the body for breastfeeding. The second trimester is also the time most women start to "show," meaning you can see their belly growing to accommodate the baby inside.
(Side note: It's typically not a good idea to ask a woman if she is pregnant just because her belly looks large. For someone who is not pregnant, this can be taken as an insult.)
Some second trimester symptoms you may experience include:
- increased appetite
- backaches
- leg cramps
- heartburn
At this stage, babies begin moving in the womb and at roughly 20 weeks they begin recognizing their mother’s voice. Medical appointments and tests continue through the second trimester. Parents can usually find out the sex of the baby at this point.
The third trimester
Appointments with the doctor become even more frequent during the third trimester. Your doctor may give you travel restrictions in case they go into labor earlier than expected or for other medical reasons. Remember, the due date is just an approximation, and a woman can give birth at almost any time towards the end of the third trimester.
Doctors will share a lot of information about labor and delivery and may even suggest taking a class about labor or parenting skills. Depending on the specifics of your pregnancy, doctors might suggest a C-section as a safer delivery alternative to vaginal birth. This would mean the delivery would occur by surgery on a set date in the hospital as opposed to waiting to go into labor.
After the baby is born
Once the baby is born, your doctor will recommend tests to check for any abnormalities and make sure the baby is healthy. When a woman living with HIV has a baby, the newborn will need to start HIV medication right away and stay on it for 6 weeks. Babies usually are prescribed one medication, administered as a liquid every 12 hours. A nurse in the hospital will make sure you know how to give the medication to your baby correctly before you leave the hospital. It is crucial that baby is given every dose, every day to ensure protection from HIV.
If you choose to breastfeed, it is important to take your HIV drugs, and keep up with health care visits and viral load testing, exactly as prescribed and recommended by your provider. In January 2023, the Perinatal HIV Clinical Guidelines were rigorously updated to encourage breastfeeding among women living with HIV. Learn more about these updates and tips to help you do so safely.
(Note: If dad is the person living with HIV and mom is not, the baby does NOT need to take medication and no other precautions are necessary.)
If you’re a mom living with HIV, your baby will have two pediatricians for a little while. A regular pediatrician that sees all kids, plus a specialist pediatrician in the Pediatric Infectious Disease clinic. This doctor has expertise in making sure babies born to moms living with HIV are healthy and HIV-free.
Babies are born with their mother’s antibodies. This means that a regular HIV test will not be accurate for a baby. Instead, the doctor will likely order a special HIV DNA test to check for the virus itself instead of the antibodies. Typically, your baby will have an appointment with the specialist and get blood drawn when the baby is 2 weeks old. This is repeated at 8 weeks, 4 months, and 18 months. If the baby’s HIV DNA test is negative at the 18-month mark, no further HIV testing is needed, and you can rest assured that your baby definitely is NOT living with HIV. (Yay, science!)
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