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HIV in pregnancy

Read our guide below about human immunodeficiency virus (HIV) in pregnancy.

You can also download a PDF version of this patient information by following the link on the right.

This page explains:

  • what it means for you and your baby if you have HIV
  • what the guideline says about the most effective ways of treating you during your pregnancy and labour
  • how to protect your baby from HIV during pregnancy, birth and in the first weeks of your baby’s life.

What is HIV?

HIV damages the body’s immune system and makes it difficult to fight off infections.

You can pass HIV from one person to another through body fluids. These include:

  • blood
  • semen
  • vaginal fluids
  • breast milk.

If you have HIV it’s known as being HIV positive. You’ll have antiretroviral drugs to block the action of the virus. The drugs work best when you take 3 or more types together. They may be available as a combination in one or two tablets.

You’ll have specialist care and regular health checks during your pregnancy.

What does having HIV mean for my baby?

If you’re HIV positive you can pass the virus on to your baby:

  • through the placenta while you’re pregnant
  • during the birth
  • through your breast milk.

You can reduce the risk of this happening by:

  • taking antiretroviral drugs
  • having a planned (elective) caesarean section
  • avoiding breastfeeding your baby
  • giving your baby medication for 4 weeks after birth.

What extra antenatal care can I expect?

We’ll offer you specialist care and regular health checks by a team of specialists including:

  • doctors and a clinical nurse (who specialises in HIV)
  • an obstetrician (doctor who specialises in the care of pregnant women)
  • a midwife
  • a paediatrician (doctor who specialises in children’s health)
  • other specialists if you need them
  • your GP who also forms a crucial part of the team. We’ll tell your GP about your progress.

If you’re not taking antiretroviral drugs already, your doctors will recommend starting them during your pregnancy. This helps to stop you from passing the HIV virus to your baby and keep you well.

Screening tests

As well as routine screening tests, we’ll offer you other tests to check for sexually transmitted infections.

We recommend that you have tests for vaginal and sexually transmitted infections early in your pregnancy. An undiagnosed and untreated infection can:

  • infect your baby
  • affect your pregnancy
  • increase the risk of passing on HIV to your baby

If we offer you an amniocentesis as part of the screening tests, there’s a risk of passing the virus to your baby. It involves putting a needle through your abdomen to take a sample of fluid around the baby. To reduce this risk, we may offer you treatment with antiretroviral drugs if you’re not already taking them.

Antiretroviral drugs

The risk of your baby becoming HIV positive will reduce to almost zero by taking antiretroviral drugs.

Your HIV specialist will talk to your antenatal healthcare team and recommend which drugs they think are best for both you and your baby. They’ll tell you when you should start taking them.

Antiretroviral drugs are generally safe but can sometimes have side effects including:

  • stomach and digestive problems
  • liver problems
  • rashes
  • diabetes
  • fatigue (tiredness)
  • high temperature
  • breathlessness.

If you experience other side effects and want to ask anything else related to your treatment please speak to your midwife.

Some of these symptoms can also be the symptoms of pre- eclampsia and cholestasis. Pre-eclampsia is a condition that causes high blood pressure and can occur in the second half of pregnancy. It may be more common in women who take some types of antiretroviral drugs. Cholestasis is a liver disorder.

If you show any signs of pre-eclampsia or cholestasis an obstetrician should see you as soon as possible, as they can cause serious problems for you and your baby if they are not detected and treated.

Talk to your doctor or midwife if you’re worried about anything.

What if I don’t want to take antiretroviral drugs?

Fewer than one HIV positive people in every 50 who takes antiretroviral drugs passes the HIV virus on to their baby. About a quarter of all people who don’t take antiretroviral drugs (12 or 13 in every 50) pass on HIV to their baby.

If you don’t take antiretroviral drugs it’s much more likely you’ll pass on the HIV virus to your baby. Your doctor will probably recommend a caesarean delivery to reduce the risks.

If you’re already taking antiretroviral drugs

Your doctor will normally recommend that you continue taking them.

If you’re diagnosed late in pregnancy or during labour

We’ll offer you antiretroviral drugs during the rest of your pregnancy and after your baby’s born.

What’s the best way to give birth?

Your doctors will discuss with you the risks and benefits for you and your baby of the childbirth methods you’re considering

If you have no detectable levels of virus (undetectable viral load) at 36 weeks, we’ll recommend a vaginal delivery unless there are other reasons for having a caesarean.

If the quantity of virus present is at a detectable level, a planned caesarean section may further reduce the risk of HIV for your baby. We usually do a caesarean when you’re 39 weeks pregnant.

Whatever method you choose, we’ll take a sample of your blood at the time of the birth to check the amount of the virus in your system.

What happens if I have a planned caesarean section?

We’ll offer you antibiotics to reduce the risk of other infections. If we detect the HIV virus in your blood, we’ll offer you an infusion of Zidovudine, beginning 4 hours before your caesarean. The infusion delivers the drug at a steady rate through a drip (a needle inserted into a vein in your hand or arm) and will continue until your baby’s born and we clamp the umbilical cord.

This won’t be necessary if you have no detectable levels of virus.

What happens if I have a planned vaginal birth?

We’ll offer you antiretroviral drugs during your labour.

We don’t normally recommend a Zidovudine drip is not normally recommended. In theory, the earlier in labour that your waters break, the higher the risk of passing on the HIV virus to your baby.

Your healthcare team will delay breaking your waters for as long as possible. They’ll also avoid putting a fetal scalp electrode on the baby to monitor its heartbeat, or taking blood samples from your baby before it’s born.

Delayed cord clamping can happen. There’s no evidence that it increases the chance of your baby getting HIV if your viral load is undetectable.

What happens if my waters break early?

After 37 weeks

If your waters break before you go into labour and we can’t detect your viral load, it may be possible to induce labour with a drip to start contractions. We’ll do this straight away.

If your waters break before your planned caesarean section, you should come the hospital immediately. We’ll do caesarean as soon as possible.

Before 37 weeks

If your waters break before your contractions start, your team will discuss with you whether it would be better for your baby to be born instead of waiting. This will depend on how far you are in your pregnancy and your individual risk of transmitting HIV to the baby.

What’s the best way to feed my baby?

If you’re HIV positive, we’ll strongly recommend using an alternative such as formula milk. If you don’t breastfeed or use your own expressed breast milk, you can greatly reduce the risk of passing HIV to your baby.

Will anyone else know that I have HIV?

Only your healthcare team need to know that you’re HIV positive, so they can provide the best care possible for you and your baby. You ‘ll need to discuss with them what’s said about your HIV in your medical notes. Your healthcare team will not tell anyone else without your permission, except in the cases below.

Your healthcare team will encourage you to tell any sexual partner you have. This is to reduce the risk of passing on the HIV virus. If your healthcare team thinks that by not telling a sexual contact that you’re HIV positive, you’re putting that person’s life at serious risk, they may tell that contact.

This is approved by the General Medical Council but the team must discuss this with you first. If they decide to reveal your HIV status to a sexual contact, they must be able to show why they think this is necessary.

About this information

This is a rapidly changing area of knowledge, so the advice may change. This information is based on the British HIV Association (BHIVA) guidelines for the management of HIV infection in pregnant women 2012 (interim 2014) and was correct at the time of writing.

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or

About our patient information

We aim to make the information as up to date and accurate as possible, but please note that it’s subject to change. You must always check specific advice on any concerns you may have with your doctor.

Contact us

Buckinghamshire Sexual Health and Wellbeing Service
Consultant obstetricians, Stoke Mandeville Hospital
Consultant obstetricians, Wycombe Hospital
Buckinghamshire Sexual Health and Wellbeing Service

0300 303 2880 (option 4)

Consultant obstetricians, Stoke Mandeville Hospital

01296 316239 


01296 316548

Consultant obstetricians, Wycombe Hospital

01494 425009


01494 425724