Many women have benefited from the new antiretroviral combinations. Because of the improvement in their health and survival, women with HIV are increasingly considering pregnancy.
What are some of the considerations?
Q: Will my HIV affect my ability to become pregnant?
A: Women with HIV have decreased fertility rates compared to HIV negative women, however, to become pregnant, you must have unsafe sexual intercourse which puts your partner at risk for HIV.
Q: Will a pregnancy accelerate the course of my HIV infection?
A: There is no evidence that pregnancy is associated with increased HIV progression (more rapid declines in CD4
count, or more rapid increase in viral load). There is no evidence that HIV causes birth defects.
Q: Will HIV affect the course of pregnancy?
A: A number of studies have shown that HIV infected women may deliver prematurely and that their infants will have lower birth weights than uninfected women.
Q: What are the chances that my baby will be HIV-infected?
A: The risk of transmission from an HIV positive woman to her baby is approximately 25%.
This risk is higher for women with lower CD4 counts and higher viral loads. Most transmission occurs during the
birthing process, although it may occur during the pregnancy or by breast feeding. It is, therefore, recommended that women with HIV not breast feed their babies.
Q: Can anything be done to decrease the risk?
A: Study ACTG 076 demonstrated that the use of AZT can decrease the risk of perinatal transmissiion to
approximately 8%. The woman is given oral AZT during pregnancy, intravenous AZT during labour and delivery and the baby is given oral AZT for the first few weeks of life.
Q: What about the use of other antiretroviral drugs?
A: The safety of other antiretroviral drugs in pregnancy is currently unknown. Most experts feel that the woman
should receive combination antiretroviral therapy in the same manner as if she was not pregnant.
It is necessary, however, to balance the optimal treatment of the mother and the potential to decrease perinatal
transmission versus the unknown potential to cause birth defects. You should consult your doctor if you become pregnant to determine the best treatment for you and for your baby.
MotheRisk Help Line is another source of information that you can reach by telephone, locally at (416) 813-6780,
toll-free at 1-888-246-5840 or on the internet at www.motherisk.org. A registry has also been developed to collect data on the use and safety of antiretroviral drugs in pregnancy.
Q: What about the role of Cesarean section?
A: Some studies have shown that Cesarean sections may decrease the risk of material transmission and other studies have not. Currently, routine Cesarean sections are not recommended.
Q: What else should I consider?
A: Even though your health may be improved by antiretroviral therapy, there are other factors that you should consider.
If you and/or your partner become ill or die from your HIV, who will care for your child?
If your child becomes infected, you may experience considerable guilt. Are you prepared to watch your child suffer and possibly die from HIV?
Deciding to become pregnant when HIV infected is a big decision. Make sure you discuss the implications with
your partner and with your doctor. Although treatments can decrease the risk your baby will become infected, this cannot be guaranteed with certaintly.
