In recent years, almost all HIV infections occurring in U.S. children have been the result of mother to child transmission. However, the epidemic is slowly coming under control. In 2005, only approximately 141 children were born with HIV, which is less than one-tenth the number of infected children born each year in the peak years of the mid 1990s. Much of this reduction has been attributed to early identification of HIV infection in pregnant women, so that antiretroviral therapy and other interventions during pregnancy, labor, and delivery can be started to prevent transmission to the baby. This type of therapy, combined with treatment of the newborn, can reduce the risk of perinatal HIV transmission from approximately 25% to less than 2%.
Unfortunately, in order for treatment to do be as helpful as possible, women need to be diagnosed with HIV as early as possible during pregnancy. This is why current CDC guidelines recommend testing for all women during the first prenatal visit and then again during the third trimester. However, even women who don't get tested during pregnancy can benefit from testing at the time of delivery. Treatment during delivery has been shown to reduce the rate of HIV transmission to the infant by more than half.
In 2007, more than one quarter of women who gave birth to an HIV infected infant had no idea they were infected until it was time to give birth.
Knowing is Half The Battle
In 2005, slightly more than one-quarter of the newly diagnosed HIV infections in the United States occurred in women, and many of these infections were the result of sexual relationships with HIV positive men. Furthermore, 80% of the estimated 120,000 to 160,000 HIV positive women in the United States are of childbearing age, and as many as a quarter of these women may not know their status. These women, who don't know their HIV status, may be at the highest risk of passing the virus on to their children if they choose to become pregnant, particularly if they do not receive HIV testing, and treatment, as part of timely prenatal care.
If you become pregnant, it is extremely important for you to be tested for HIV as early as possible during your prenatal care. Even if your risk of exposure is minimal, it is better to be safe than sorry. Knowing your HIV status will help with your peace of mind. More importantly, however, if you are positive, the sooner you start treatment, the safer you can keep your future child.
If you are pregnant, and you don't know your HIV status, ask your doctor to test for HIV you as part of your prenatal care. Although all doctors should be offering HIV tests to every pregnant patient, many do not. That's unfortunate, because universal testing and treatment of pregnant women could help eliminate mother to child transmission of HIV.
Choosing to Become Pregnant When HIV+
In these days of highly active antiretroviral therapy (HAART), HIV has become a disease that people are living with for decades. Many HIV positive men and women are interested in having children of their own. Although the risks of transmission during pregnancy have not been eliminated, new treatments and technologies have made it much safer for HIV+ couples to have children.
If you are part of a couple where one or both of you is HIV positive, and you are considering having children, it is important to see your doctor for counseling before trying to become pregnant. Your doctor can help you decide whether trying for a natural pregnancy is right for you. And, if it is, they can help you reduce the risk of transmission to you, your uninfected partner and/or your future child. Other options for childbearing may include use of assisted reproductive technologies or adoption, and, after counseling, some couples may decide to remain child-free.
If either you or your partner is HIV positive, it doesn't have to be the end to your dreams of having a family. However, it can make the decision making process more difficult. Therefore, it is important to begin the process with as much information as possible. If your physician is uncomfortable discussing reproductive options with you, seek out someone else who will give you the help that you need. It's better to wait and do it right than to risk the health of your future child any more than absolutely necessary.
Basic HIV/AIDS Statistics from the Centers for Disease Control.
One Test. Two Lives. HIV Screening for Prenatal Care from the Centers for Disease Control. Accessed Online 08/08/12
The Perinatal HIV Fact Sheet from the Centers for Disease Control. Accessed Online 08/08/12 at: http://www.cdc.gov/hiv/topics/perinatal/resources/factsheets/perinatal.htm
Barreiro P. et al. (2006) "Reproductive options for HIV-serodiscordant couples." AIDS Rev. 8(3):158-70.