Human immunodeficiency virus (HIV) damages the immune system, making it harder to fight infections. It can be passed on through blood and other body fluids, for example through sexual contact or infected needles.
There’s no cure for HIV but most people live long, healthy lives with antiretroviral medication. Mothers can pass HIV to their babies during pregnancy, birth and breastfeeding but by following a treatment plan 99% of HIV-infected women will not pass HIV to their babies.
Testing for HIV during pregnancy
All women are offered a blood test at their first antenatal appointment, called the booking appointment. With your permission one of the things that your blood is tested for is HIV. It’s your choice whether to have this test but it is a good idea to have the test as a plan will be put in place to stop HIV passing to your baby if you do have it.
You can also have another test later in pregnancy if there’s a chance you were exposed to the virus after the first test. Tell the midwife if this happens and you will be offered another test in the last 3 months of pregnancy.
If you take antiretroviral medication, don’t stop taking it until you have spoken to your midwife or HIV team. They may advise you to change to a medicine that is safer for your baby. If you don’t already take medication, your doctor may advise you to start taking it during pregnancy to help protect you and your baby.
What can I do to reduce the risk of passing HIV on to my baby?
If you already know you have HIV, talk to your GP or HIV team before you get pregnant if possible. If you’re already pregnant, you can speak to your GP or midwife.
They may refer you to an antenatal HIV team. This team may include an HIV specialist, a doctor who specialises in pregnancy and childbirth (obstetrician), a specialist midwife and a doctor who treats children (paediatrician). They may also put you in touch with local support groups.
You and your health care professional will discuss things you can do to reduce the risk of passing HIV to your baby. They include the following:
- Taking a combination of antiretroviral drugs during your pregnancy.
- Having your baby by c-section if tests show that your level of HIV is high.
- Taking antiretroviral drugs during labour and delivery if they are recommended.
- Giving antiretroviral drugs to your baby after birth.
- Bottle-feeding instead of breastfeeding.
Giving birth with HIV
Having HIV will affect your choice of where and when to give birth. You will be advised to give birth in a hospital rather than at home even if your treatment is well-managed. This is because your baby will need to be tested after the birth to see whether they need treatment to prevent the virus being passed to them.
- If the level of HIV in your blood is high you will be advised to give birth in a hospital by caesarean section. This reduces the chance of passing it on to the baby.
- If the level of HIV in your blood is low you will be able to give birth vaginally as there is a much lower risk of passing it to your baby during the birth.
Looking after your baby if you’re living with HIV
The safest way to feed your baby is with formula milk. If your HIV is well controlled with antiretroviral medication, the risk of passing the virus to your baby through breastfeeding is low. Your GP or HIV team can help you choose how you want to feed your baby.
Your baby will have blood tests in the weeks and months after birth to check they haven’t got the virus. If you’re breastfeeding, you and your baby will have these tests more often.
- NHS (2018) HIV and AIDS: overview. www.nhs.uk/conditions/hiv-and-aids/
- The American College of Obstetricians and Gynecologists (2017) HIV and Pregnancy https://www.acog.org/Patients/FAQs/HIV-and-Pregnancy?IsMobileSet=false
- Scott RK (2019) BMJ Best Practice: HIV infection in pregnancy. https://bestpractice.bmj.com/topics/en-gb/556
- NHS (2018) Screening for hepatitis B, HIV and syphilis. www.nhs.uk/conditions/pregnancy-and-baby/screening-blood-test-infectious-diseases-pregnant/
- British HIV Association (2019) British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 (2019 second interim update). www.bhiva.org/file/5bfd30be95deb/BHIVA-guidelines-for-the-management-of-HIV-in-pregnancy.pdf
- Prevention Access Campaign (2016, updated 2019) Risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load: Messaging Primer & Consensus Statement. https://www.preventionaccess.org/consensus
- NHS (2018) Living with HIV and AIDS. https://www.nhs.uk/conditions/hiv-and-aids/living-with/
- NHS (2018) Can HIV be passed to an unborn baby in pregnancy or through breastfeeding? www.nhs.uk/common-health-questions/pregnancy/can-hiv-be-passed-to-an-unborn-baby-in-pregnancy-or-through-breastfeeding/