Medically reviewed by Emily Barr, PhD, RN, CPNP-PC, CNM, ACRN, FACNM, FAAN
It might feel overwhelming if you’re living with human immunodeficiency virus (HIV) and want to get pregnant. You might wonder if you could pass on the virus to your baby, or if you can keep taking your HIV medications while pregnant. These concerns are valid.
But many women living with HIV can and do go on to deliver a healthy baby. Every year, 3,500 people living with HIV in the United States give birth.
We’re here to provide some answers that may ease your mind and help you have a conversation with your healthcare provider.
Can I get pregnant if I have HIV?
Yes, you can. But it’s ideal to talk with your HIV specialist before you get pregnant. This can help make sure you’re at your healthiest before getting pregnant, allow for any medication adjustments, and help keep you from transmitting HIV to your baby.
Of course, surprise pregnancies can happen, so if you find out you’re pregnant, let your healthcare provider know as soon as possible.
As long as you are on medications for HIV and your viral load remains undetectable, your chances of transmitting HIV to your baby can be less than 1%. An undetectable viral load means the amount of HIV virus in your blood is so low that a lab test can’t pick up the virus.
Being pregnant at age 35 or older (called advanced maternal age or geriatric pregnancy) comes with certain health risks compared to people under age 35 regardless of your HIV status, including:
- Higher rates of miscarriage
- Increased risk for genetic conditions
- Pregnancy complications, such as high blood pressure or diabetes
The research is limited on those who are living with HIV and are pregnant over age 35, but it is possible that there may be higher risks.
Can I continue HIV medications while pregnant?
Yes, you can and, in fact, you should. It’s important to take HIV medications while pregnant to help protect both your health and the health of your baby. This can greatly reduce the chances of transmitting HIV to your baby.
Don’t skip doses and take your medications at the same time every day to keep your viral load as low as possible.
Many of the medications for HIV are thought to be safe to take when you’re pregnant. But, depending on what you take and how far along you are in your pregnancy, your healthcare provider might suggest you change up some of the HIV medications you’re currently taking if you do become pregnant. It’s important to talk to your healthcare provider to find out what the pros and cons of the possible medications are.
What are the risks to the baby if I’m living with HIV?
Most babies who get HIV, get the virus during delivery. If you’re having a vaginal birth, your healthcare provider may give you medications through an IV (intravenous) line that can lower the chances of transmitting the virus to your baby. If your viral load is high, you might have a cesarean section and get IV medication. This can help decrease the risk of transmission.
HIV can also pass through the placenta and infect the baby in utero. But, if you continue to take your HIV medications as directed throughout your pregnancy, labor and delivery, and give your baby HIV medications for two to six weeks after they’re born, your baby has less than a 1% chance of getting HIV.
Studies have shown that women who are living with HIV are up to two to three times more likely to have pregnancy complications than HIV-negative women. These complications can happen even if the HIV-positive women are taking antiretroviral therapy (ART). Possible complications include:
- Miscarriage or stillbirth
- Having a baby who is born with a low birth weight
- Preterm, or very early, delivery
Can I breastfeed if I have HIV?
You can choose to feed your baby your milk through breastfeeding, chestfeeding or pumping with a greater than 99% chance of not transmitting HIV if you are on HIV medications and your viral load is undetectable. The pros and cons should be discussed with your key family members and your HIV specialist to make the best decision for you and your baby.
If you are on ART, the World Health Organization guidance for breastfeeding is the same as for people who are not living with HIV.
Can I take PrEP while pregnant or breastfeeding?
It is safe to take PrEP (pre-exposure prophylaxis) while you’re pregnant or breastfeeding to prevent HIV transmission. PrEP is safest when taken as a daily pill because PrEP injections aren’t approved in pregnancy.
PrEP is taken by people who don’t have HIV but are at high risk. You might want to take PrEP if you have a partner who is living with HIV, have or have had unprotected sex, or share or have shared needles during injected drug use.
If your partner has HIV, it’s also a good idea to test often because the risk of transmitting the virus to your baby is highest if you get the virus during pregnancy or while breastfeeding.
Will I be considered a high-risk pregnancy and need more doctor appointments?
Yes, your pregnancy will be considered high risk because living with HIV can put you at an increased chance of pregnancy complications, such as miscarriage, stillbirth and low birth weight. And you will have more appointments because you will need to see your HIV team as well as your OB team. Your healthcare team, including your HIV specialists and your OB or midwife, will want to monitor you more closely in order to plan for a healthy birth and avoid complications. They will check routine prenatal labs like your kidney and liver health, iron levels, blood sugar and also how well the HIV medications are working.
You also might be offered certain vaccinations such as influenza, Tdap, RSV, Covid-19, pneumococcal and hepatitis A and B if needed.
We’ve come a long way, and it’s not only possible but likely that your baby will be born without HIV. Talk with your healthcare team about how you can have the healthiest pregnancy possible while living with HIV.
This educational resource was created with support from Merck.
This article was originally published on healthywomen.org.