NHS Greater Glasgow and Clyde: Sexual Health

You are here: Home > Pregnancy > After Childbirth

Finding out you are HIV-positive during Pregnancy

All pregnant women are now offered a test for HIV as a routine part of antenatal care. If you do not want this test you must tell your doctor when asked, otherwise it will be carried out along with other routine checks. You have the right to refuse this test, and you also have the right to be fully informed about the pros and cons of taking the test, to help you make up your mind. The test is never done without asking you first.

Women who discover they are HIV-positive during pregnancy will need to consider a lot of information, and make important decisions quite swiftly. It is essential that these women are given sufficient time, accurate information and good support to take such important decisions. It is very likely that there will be positive and negative outcomes from whatever decisions they make.

Issues for an HIV-positive woman wanting to become pregnant with an HIV-negative man

There is a risk that unprotected sexual intercourse with an HIV-positive woman will lead to infection of a HIV-negative male partner. However, if this is the case and the woman wishes to become pregnant it is possible to prevent the male partner becoming infected if the woman uses a self–insemination kit. This simple procedure involves the woman inseminating herself, at the time she is ovulating, with her partner's sperm which has been collected in a sterile pot. Most hospitals or women's health organisations can offer advice and appropriate equipment.

There are also a number of issues to consider if you are taking HIV treatment. For instance, if you don't take any HIV treatments, there's about a 1 in 4 chance that your baby will be born with the virus. If you take drugs to slow down HIV, the chance that your baby will get HIV is only about 1 in 10. However, by having a caesarean section and not breastfeeding you can reduce the risk of your baby becoming infected with HIV by even more.

If you have HIV and you're pregnant, you'll be given drugs to slow down HIV late in your pregnancy (usually around 28 or 35 weeks). Your baby will also be given drug treatment for HIV soon after he or she is born. The risk of passing the virus on to your baby increases as the infection gets worse.

Issues for an HIV-negative woman wishing to become pregnant with an HIV-positive man

If the father is HIV-positive but the mother is not, the baby will not be directly infected from the father's sperm. If the woman becomes infected during conception there is significant risk of transmission to the baby.

Sperm washing

One option for couples where the male is HIV-positive and the woman HIV-negative may be sperm washing. A semen sample can be 'washed' and used for insemination. A woman wishing to conceive by this method will be monitored to determine when she is due to ovulate, and then her partner will be asked to provide a sperm sample which is washed before testing it for HIV. So far there have been no cases of HIV transmission to the female partner with this method. However, unfortunately, few centres in the UK offer this service and NHS funding remains limited.

It is important to note that sperm washing is look upon as a risk-reduction process and not a fertility treatment.

Artificial insemination

Another option for a woman who is HIV–negative and whose partner is HIV–positive might be artificial insemination with another man's semen either from an anonymous donor, or someone known (such as a member of her partner's family). This is an option that many women use if their partner is infertile or risks passing on other infectious.

Issues for HIV-positive couples

For HIV–positive couples taking combination treatments, it is important to discuss conception (and contraception) plans with their health care provider or a suitably qualified person, preferably before conception.

Until recently it was thought that pregnancy could have a negative effect on a woman's health as the immune system might be further suppressed by pregnancy. It now seems that pregnancy is only likely to have an impact on a woman's physical health if she is already unwell, or has very low CD4 counts.

If both partners are HIV-positive it is particularly important that they consider the long term future of the child, in particular who will care for the child if one or both parents are unable. For some HIV–positive women the risk of passing on HIV to the foetus is too high for them to carry on with a pregnancy, or to take the risk of conceiving a child. For others, living with a life–threatening condition may intensify the desire for children.

Reducing Infection Risk for the Baby

Transmission to a baby occurs when virus from an infected mother is passed on to the child in the womb (through the umbilical cord, which is the tube that links the mother's blood vessels to the baby), during delivery, or during breast-feeding.

Irrespective of whether a baby is HIV-positive or not, all babies born to women with HIV acquire maternal antibodies, and it is not easy to differentiate their own from their mother's. These maternal antibodies persist for approximately ten months, and may last as long as eighteen months.

All infants born to HIV-infected mothers should ideally receive a six week course of medication, and should not be breast-fed.

Although the majority of babies born to women with HIV are not infected, health care workers will understandably usually treat the baby as HIV infected until their HIV status is clarified.

Until recently, the life expectancy of children with HIV was not high. With combination therapy and continuing developments life for HV-positive children is now extended.