What to Expect

BEFORE YOU GET PREGNANT: ' First, consult your doctor before trying to conceive. 'You should seek an obstetrician who specializes in HIV care and preconception counseling,' says Alice Stek, MD, director of perinatal services at the Maternal-Child Adolescent HIV Program at Los Angeles County'University of Southern California Medical Center. 'A lot of obstetricians may not have the knowledge to properly care for a woman with HIV who is trying to conceive and care for a child, and a lot of HIV centers or clinics don't deal with pregnancy enough to know all of the proper care.' An obstetrician who has a strong knowledge of HIV can correctly evaluate whether the woman needs to be on medication prior to pregnancy; whether she should wait until she's pregnant to change, start, or stop medication; and which drugs are safe to take during pregnancy. ' Stek recommends would-be mothers plan on spacing pregnancies at least two years apart to prevent any complications or premature births that might occur with the second child. DURING PREGNANCY: ' Like all expectant mothers, pregnant women with HIV should stop drinking, smoking, and using narcotics, and should avoid excessive amounts of caffeine immediately after conception. ' Stek recommends that women take extra folic acid supplements, in addition to any folic acid that may be in prenatal vitamin packs. ' Conversely, she says, avoid taking too much vitamin A. Though some doctors recommend high doses of vitamin A for HIV-positive women, Stek says it's the one vitamin that could lead to birth complications if more than the standard 5,000 milligrams are taken per day. 'Just because it's a vitamin doesn't mean it's harmless,' she says. WHILE IN LABOR: ' If a woman is on highly active antiretroviral therapy (HAART), there is not much need for a cesarean birth, says Audra Deveikis, MD, of the Bickerstaff Pediatric Family Center at Miller Children's Hospital in Long Beach, Calif. Once doctors found out that HAART reduced the mother-to-child transmission rate by 70%, the need for cesarean births for HIV-positive mothers diminished. ' An IV drip of AZT is administered to the woman as a way to pre-load the baby with the drug to prevent transmission during labor. AFTER THE BIRTH: ' Breast-feeding is not recommended for HIV-positive women. If an HIV-positive woman does breast-feed, she puts her child at a 14% risk for transmission. 'In this country,' Stek says, 'we have access to clean water and a reliable supply of formula. [HIV-positive mothers breast-feeding] is just not a good idea.' She also advises caution when considering whether to use a breast milk bank. 'I would be worried about that, unless it's well regulated and you know the donors of the milk are healthy.' ' After the baby is born, he or she will be subjected to several tests to ensure there was no HIV transmission. 'Even if the mother's blood markers are good at the time of delivery, it's not a guarantee that the baby does not have the virus,' Deveikis says. Her center tests babies for HIV at the one-day, one-week, one-month, two-month, and four-month marks.