HIV and pregnancy – everything you need to know to keep baby safe

Mother-to-child transmission is the greatest source of HIV infection in young children. 1 in 3 pregnant women are HIV positive and it has been estimated that 50 000 HIV positive babies are born in South Africa each year.

Can my unborn baby get infected with HIV if I have been diagnosed?

An HIV positive woman can transmit the HIV virus to her baby during pregnancy, labour, delivery and through breastfeeding. Maternal HIV expert, Dr Vivian Black says if the right procedures are followed, however, the chances of a baby becoming infected with HIV are actually very low. “Many people have the perception that an HIV positive mother will always give birth to an HIV positive child, but this is not the case, as the sperm and egg are not infected with HIV.”
Modern drugs have proven very effective in preventing HIV transmission during pregnancy, labour and delivery. Dr Black says thousands of women have taken ARVs during pregnancy without causing harm to their babies. The treatment has resulted in many babies, who might otherwise have been born infected, being born HIV negative.

The AIDS Healthcare Foundation (AHF) has this advice to reduce your baby’s chances of contracting HIV:

  • If you are planning to start a family, talk to your healthcare provider about medications to prevent mother-to-child transmission of HIV.
  • If you’re not already taking antiretroviral treatment (ART), begin taking ART before you become pregnant in order to strengthen your own health and reduce the risk of passing the virus to your child.
  • When you go in to deliver your baby, remember to ask for the medication you will need to take to prevent passing the virus to your child. If you are not taking antiretrovirals (ARVs), you will receive one dose and your baby will be given a six-week course to take.

Dr Black also has the following advice to prevent mother-to-child HIV transmission:

  • Get adequate antenatal care, and start a course of ARVs if you haven’t already.
  • Follow a healthy eating plan, treat any infections you may have and follow a gentle exercise routine.
  • Always opt for an elective C-section if possible.
  • Formula-feed your baby exclusively if you can afford it, sustain it and do it safely. If you can’t do this, it is best to exclusively breastfeed your baby.
  • Abstain from alcohol and cigarettes.

C-Section or natural birth?

There is a relatively high risk of HIV transmission during vaginal delivery due to the presence of the virus in the blood and mucus in the birth canal. However, recent research suggests that taking triple ARV therapy during pregnancy is as effective as having an elective C-section in preventing the transmission of HIV from mother to baby.
However, Dr Black says an elective C-section is best, but you can have a natural birth if your viral load is low. Elective Caesareans are not available in government hospitals unless you have an obstetric indication for one. Obstetric indications include several reasons like a previous C-section or the baby being too big to deliver vaginally, or if you are too small for a vaginal delivery.

ALSO SEE: 11 reasons why your gynae might insist you have a C-section

Yes. The Worl Health Organisation (WHO) recommends these guidelines for HIV-infected mothers who are advised to breastfeed.

More about the expert:

Dr Vivian Black was  the Director of the Clinical Health Programme at the Wits Reproductive Health and HIV Institute for 5 years. She has her master’s in Infectious Diseases and a background in Medical Microbiology. She has assisted the South African Department of Health with guideline development and contributed to developing PMTCT, Adult Treatment Care and Support and Sexually Transmitted Infection Management policies. Dr Black has over 40 publications in the field of maternal health and infectious diseases, is and active researcher and provides ongoing Health System Strengthening assistance. Learn more about Dr Vivian Black here.

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