Positive women do it all the time. The best time to start planning for a safe pregnancy, supportive health care and an HIV negative baby is now. Liz Highleyman reports
If having a baby is one of your dreams, HIV doesn’t have to stand in the way. Thanks to advances in treatment and prenatal care, the risk of mother-to-child HIV transmission is now less than 2% in the U.S.—down from about 25% in the early 1990s. And studies show that pregnancy has no effect whatsoever on your HIV infection. Whether you’re gearing up right now to expand your family or just want to make sure your body is in the right shape for that possibility later on, however, there are a few key things to think about.
Step One: Think Ahead Getting healthy is the best thing you can do for any babies in your future—and for yourself. So don’t forget to think beyond HIV: Do you have diabetes or hepatitis? What about STDs? Women of color have a higher risk of preeclampsia (a life-threatening increase in blood pressure during pregnancy), and African Americans are more likely to have low-birth-weight babies. Dealing with any serious health problems before conception greatly improves your chances of having a successful pregnancy and a healthy baby.
So how does a girl get pregnant? If you have HIV and he doesn’t, artificial insemination is your best bet. Some women do it themselves with a turkey baster (the man ejaculates into a cup and then one of you sucks it up with the baster and very gently places it inside your vagina), while others find professional help from a sympathetic clinic. If you both have the virus (or just your man does), sperm washing may be an option. The process—which is very expensive and still considered experimental—separates infected from uninfected sperm. (Contact Bedford Foundation Research at 617.623.7447.)
Dr. Cu-Uvin recommends preconception counseling for couples where one or both is HIV positive. And Kelly Hill at BABES network in Seattle says: “Study up!” (Check out the websites on the back page of this POZ FOCUS for a start.) “The more informed you are, the more options you have,” says Hill, who, incidentally, didn’t let being HIV positive stop her from having a healthy baby of her own. Finally, when you’re ready to start trying to conceive—or if you unexpectedly find out you’re pregnant—find an ob-gyn who has experience working with HIV positive women. (Don’t know any? Try your local AIDS service organization or the AIDS Services Directory at www.POZ.com.) Start taking prenatal vitamins, including folic acid, which helps prevent birth defects—and seriously think about quitting smoking and drinking and getting help for any drug problems you may have.
Step Two: Check Your Meds For most moms-to-be with HIV, the biggest concern is doing whatever possible to make sure the virus is not transmitted to their baby. Here’s what you need to know about the meds: If you’re already on an effective regimen, your doctor may recommend you stay put. If your combo includes AZT (Retrovir), Viramune (nevirapine), Viracept (nelfinavir) or Invirase (saquinavir), you’re ahead of the game. The first two have been shown to actually prevent transmission, and all four are considered safe to take during pregnancy (find out more at AIDSmeds.com). Most docs wait to add new meds until after the first trimester, but don’t worry if you need HIV meds the whole time: Even with early exposure, most of them don’t raise the risk of birth defects.
Meds to avoid: Sustiva (efavirenz), because it may cause birth defects, and the Videx (ddI) + Zerit (d4T) combo, because it can cause fatal lactic acidosis in pregnant women. If you don’t need HIV meds yourself thanks to a high CD4 count and low viral load, your ob-gyn will still put you on something to prevent transmission of the virus to your baby. Dr. Newman worries that taking AZT or Viramune alone might encourage your body to become drug resistant. So she would opt for a triple combo that includes one or both of those drugs.
Step Three: Plan Your Birth Now’s also the time to start considering your delivery options. If your viral load tests find your HIV “detectable,” then planning to have a C-section—before your water breaks—can reduce the risk of HIV transmission to your baby while you’re giving birth. But if your viral load is undetectable, the chances of transmission are already extremely low. And, in fact, says Newman, “If your virus is suppressed, a C-section could be more risky than a vaginal birth” (simply because of the heightened risk to anyone undergoing that kind of surgery).
During your pregnancy, your doctor will test your viral load and CD4 count frequently to make sure your HIV stays suppressed. Don’t worry too much if your CD4 numbers go down—this is common, and they usually bounce back after you give birth. Also make sure your doctor watches your blood sugar, liver enzymes and blood cell counts.
Step Four: Hello, Baby! Babies are born with their mothers’ immune systems, so they carry mom’s antibodies—but not necessarily the virus itself—for up to 18 months after delivery. To help put minds at ease, viral load tests can look for the virus in babies’ bloodstreams. But a final antibody test after 18 months is needed to confirm a negative diagnosis. Meanwhile, HIV positive mothers shouldn’t breast-feed, since there’s HIV in breast milk.
Even after your baby is born, however, treatment guidelines recommend giving your baby AZT for the first six weeks. Jill gave her son liquid meds using the nipple from a baby bottle. “It was hard,” she says, “but we never missed a dose.” The long-term effects of these meds are not completely clear yet, but research shows that 20-year-olds who’d been exposed to HIV meds before birth or as babies seem to be doing just fine.
Profile of a Mom Leslie Baptiste, 38, Florence, SC
Leslie Baptiste had had seven children by the time she was in her mid-twenties, but the eighth brought a new challenge. A former injection-drug user and prostitute in North Carolina, Baptiste was in jail—and pregnant—when she found out she had HIV in 1993. But she was given AZT (Retrovir) during her pregnancy and delivery and so was her daughter Paris after she was born. Paris was finally confirmed to be negative after 18 months of testing.
Baptiste stayed clean for a while after she got out of jail, but, she says, “I guess I wasn’t ready to start straightening up,” so she went back to getting high and working the streets. She got pregnant again, and her doctors at Duke University Medical Center prescribed the same AZT regimen for her and her son, Diamond, who also turned out to be HIV negative.
Today, Baptiste lives in Florence, South Carolina, and has been clean for two years. “I’m just living by the grace of God,” she says. “I’m trying to get myself better, get a job, get my own place.” Six months ago, she started taking Truvada (tenofovir and emtricitabine) along with Viramune. “I don’t advise anybody not to have a baby just because they’re HIV positive,” she says.