Q/A: Preventing Mother-to-Child Transmission of HIV Infection
Updated July 2017
These questions and answers are related to the material in the NYSDOH AI clinical practice guideline: Reducing HIV Transmission During Pregnancy, Labor and Delivery, and Postpartum Care.
What is mother-to-child transmission of HIV? Mother-to-child transmission (MTCT) occurs when a mother with HIV infection spreads the virus to her infant. MTCT can occur during pregnancy, labor, delivery, or breastfeeding. Learn more about MTCT
Should a woman with HIV infection disclose to her pregnancy care providers? Yes. Disclosing HIV infection to obstetrical care provider(s) will help ensure that steps are taken to prevent MTCT. This will also help protect the mother’s health.
Preventing HIV Infection While Starting a Family
Should a woman use PrEP if she wants to start a family? Pre-exposure prophylaxis, or PrEP, is HIV medication that people can take to reduce their risk of infection. People who already have HIV infection cannot use PrEP. A woman’s care provider can explain the benefits and risks of PrEP. Learn more about PrEP
HIV Testing and Antiretroviral Therapy (ART) During Pregnancy
Why do care providers recommend HIV testing to all pregnant women? Early treatment with ART will improve a woman’s health and reduce the risk of MTCT. Learn more about HIV testing
If a woman is negative for HIV early in her pregnancy, will she be re-tested later? Yes. Repeat testing is recommended during the third trimester (between 34 and 36 weeks). Steps can be taken to reduce the risk of MTCT even if HIV infection is detected late in pregnancy.
Will ART for a pregnant woman prevent MTCT? The risk of MTCT is greatly reduced if a pregnant woman’s HIV viral load is suppressed by ART. Adherence to an ART regimen is important to keeping viral load suppressed. If a woman’s viral load is detectable at delivery, she will be given intravenous (IV) antiretroviral drugs during labor to help prevent MTCT. Learn more about HIV medicines during pregnancy and childbirth
Acute HIV Infection During Pregnancy
Why is it important for a woman to see her care provider immediately if she has a rash or flu-like symptoms? These may be symptoms of acute HIV infection. The “acute” stage, which occurs right after infection, is when a person’s viral load tends to be very high. A very high viral load can increase the chance of MTCT. Learn more about the stages of HIV infection and about acute HIV infection
HIV Testing During Labor
Will a pregnant woman be tested for HIV during labor?
- Yes, if she did not receive an HIV test during her third trimester.
- Yes, if her HIV test results are not available.
- Yes, if she has a rash or flu-like symptoms at the time of labor.
- Yes, if she may have been exposed to HIV after her last HIV test.
What happens if a mother’s HIV test results are not available and she declines HIV testing during labor? According to New York State Regulations, her infant will be tested for HIV, with or without her consent, as soon as possible after birth.
Can MTCT be prevented if the mother’s HIV infection is not discovered until she is in labor? Starting ART as soon as a mother is diagnosed with HIV and starting ART prophylaxis for the infant as soon as possible after birth can still help reduce the risk of MTCT.
Does a mother’s HIV status determine how her baby will be delivered? The mother’s viral load is the most important factor in choosing a vaginal or cesarean delivery. If the mother’s viral load is undetectable, then there is no HIV-related benefit to a cesarean delivery.
- When will a scheduled cesarean delivery be recommended? 1) If a woman’s viral load has been detectable within 4 weeks of delivery, or 2) if she has had problems taking her ART as prescribed.
- When will an unscheduled cesarean delivery be recommended? 1) If a woman’s viral load is detectable and her water breaks before labor has started. Cesarean delivery will limit the infant’s exposure to the mother’s blood.
Why do clinicians delay breaking the water of women with HIV infection? Before a woman’s water has broken, her infant has not been exposed to her blood. Once her water has broken, the infant will be exposed to the mother’s blood, and infection is possible. If a mother’s viral load is undetectable, then the risk of MTCT is reduced.
Testing of Exposed Infants and HIV Prophylaxis
When babies are born to mothers with HIV infection, are they given HIV drugs? Yes. All newborns of women with HIV are given ART immediately after birth, for 6 weeks. This is called HIV prophylaxis.
How long will it take to determine whether MTCT has happened? Up to 6 months. A baby born to a mother with HIV will be tested four times after birth: 1) at 48 hours, 2) at 2 weeks, 3) sometime between 4 and 6 weeks, and 4) sometime between 4 and 6 months. An infant who tests positive for HIV at any time will be begin ART. Learn more about preventing MTCT HIV after birth
Should a mother with HIV infection breastfeed her baby? No. A mother with HIV infection should feed her baby formula only. Studies have a shown that there is a high risk of spreading HIV to a baby who breastfeeds. This is true even for mothers who are taking ART and have an undetectable viral load.
TO LEARN MORE
A few of the many resources available online to learn more are listed below:
- AIDS.gov: Preventing Mother-to-Child Transmission of HIV
- AIDSinfo.gov: Preventing Mother-to-Child Transmission of HIV
- Aidsinfonet.org: Pregnancy and HIV
- American Congress of Obstetricians and Gynecologists (ACOG): HIV and Pregnancy
- Centers for Disease Control and Prevention: HIV Among Pregnant Women, Infants, and Children
- New York State Department of Health: Pregnancy and HIV—Caring for Yourself and Your Baby
- Womenshealth.gov: Pregnancy and HIV
Online Resources for Education and Information
AIDSinfo Fact Sheets (English and Spanish): https://aidsinfo.nih.gov/education-materials/fact-sheets/
E-patients.net: Salzburg Statement on Shared Decision Making
New York State Department of Health (NYSDOH):
New York State (NYS): Office for the Prevention of Domestic Violence
Antiretroviral Pregnancy Registry: For Patients
National Institutes of Health (NIH): ClinicalTrials.gov
New York State (NYS)
New York State Department of Health (NYSDOH)