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HIV and Pregnancy
An HIV-infected woman may transmit the virus to her baby during pregnancy, during the birth process, and/or following pregnancy by breastfeeding. Again, one of the predictors of how infectious the woman will be to her baby is her viral load (how much HIV is present in her bloodstream). Women with new or recent infections, or people in later stages of AIDS tend to have higher viral loads and may be more infectious.
In 1994, researchers discovered that a course of the antiretroviral drug AZT (zidovudine) significantly reduced the transmission of HIV from woman to baby. Medications such as AZT and others are used during pregnancy and delivery to prevent transmission of HIV.
Currently, HIV is transmitted from an HIV-infected woman to her baby in about 25% of pregnancies if intervention with antiretroviral medications does not occur. Because of the widespread use of AZT by HIV-infected pregnant women in the U.S., the perinatal transmission rate has dropped dramatically, and is now less than 10% in the U.S., especially if the woman's healthcare is monitored closely and antiretroviral medications are used during pregnancy and/or delivery. In some pregnancies, caesarian section (C-section) may be recommended to reduce the risk of transmission from woman to baby. Advice about medications and C-section should be given on a case-by-case basis by a healthcare provider with experience in treating HIV positive pregnant women.
Breastfeeding is an established risk for HIV transmission. One study in Africa showed that the rate of transmission of HIV from infected mother to her child was 21% from breastfeeding. Data from New York Department of Health studies show that in the U.S., breastfeeding can add an additional 14% rate of transmission of HIV from an infected woman to her child.
In the U.S., doctors recommend that a woman who knows she is HIV-positive should not breastfeed her infant. Because of the lack of clean water and the cost of infant formula in developing countries, HIV-infected mothers in those areas may not have a choice whether or not to breastfeed their child(ren). More research is needed on ways to reduce the risk of maternal transmission through breastfeeding.
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Infection
