HIV, pregnancy and breastfeeding

Pregnancy and breastfeeding when you are living with HIV

Key points about HIV, pregnancy and breastfeeding

  • Human Immunodeficiency Virus (HIV) can be transmitted to baby during pregnancy, childbirth, or breastfeeding.
  • In Aotearoa New Zealand all pregnant women with HIV are advised to start HIV medicines. These medicines are also called antiretroviral therapy (ART) and most are safe to use during pregnancy.
  • Talk to your healthcare provider about which HIV medicines are best if you are pregnant or trying to get pregnant.
  • It is recommended that people with HIV shouldn't breastfeed or pre-chew food for their babies.
  • Talk to your healthcare provider about infant feeding options.
Woman sitting on bed bottle-feeding her baby
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For people with HIV, or who have a partner with HIV, it's a good idea to contact your healthcare provider for advice before you become pregnant. It's important to tell your doctor, midwife or lead maternity carer (LMC) about your HIV status as early as you can.

Telling your healthcare team is important because:

  • you can talk about any concerns you may have
  • it ensures you and your baby receive the best treatment throughout pregnancy and after your baby is born
  • if your medical team knows about your HIV status, they can minimise the risk of accidental transmission during any medical procedures.

For people with HIV who are pregnant, taking HIV medicine reduces the amount of virus in your body (your viral load) to a very low level.

  • If your viral load is so low that a standard lab test can’t detect it, this is called having an undetectable viral load.
  • There is a 1 in 1000 chance of transmitting HIV to the baby during pregnancy and delivery, when a woman is on antiretroviral treatment and has a viral load below 50 copies/mL (undetectable).
  • Taking HIV medicine and getting and keeping an undetectable viral load is the best thing you can do to stay healthy and prevent transmission to your baby. 

Most HIV medicines are safe to use during pregnancy. Talk with your healthcare provider about the benefits and risks of specific HIV medicines when deciding which HIV medicines to use during pregnancy or while you are trying to get pregnant.

Recommendations for your delivery will depend on your viral load, as this helps to predict how likely it is that HIV will be passed on to your baby.

Pregnant people with an undetectable viral load are usually able to have a vaginal birth, however this decision should be made in discussion with the team looking after you. An elective caesarean section may be recommended if you have a higher viral load. You may also be recommended to have an antiviral medication (zidovudine) during labour. After your delivery, the paediatric team will assess your baby and make a management plan to reduce the chance of your baby getting HIV (this usually involves blood tests and giving your baby ART).

The current recommendation in Aotearoa New Zealand is that people with HIV shouldn't breastfeed or pre-chew food for their babies.

In Aotearoa New Zealand, infant formula is a safe and readily available alternative to breast milk. Keeping an undetectable viral load substantially reduces, but doesn't completely take away, the risk of transmitting HIV through breastfeeding. If you have questions about breastfeeding or want to breastfeed, talk to your healthcare provider about infant feeding options. 

If you have HIV and want to breastfeed it's important that you're fully informed before you decided. An informed choice is when you:

  • know about and fully understand all the options before you make a decision
  • are aware of the possible risks and benefits of breastfeeding, and know what the alternative options are. 

Read more about the Ministry of Health's recommendations and feeding options for babies whose mothers have HIV(external link) from Positive Women.

Body Positive NZ(external link) is a peer support organisation for all people living with HIV in New Zealand
Toitu te Ao Inc(external link) offers support, advocacy, information and education for Māori 
Positive Women NZ(external link) support organisation for women and families living with and affected by HIV

HIV, pregnancy and women's health(external link) Positive Women, NZ, 2019 more resources(external link)

References

  1. HIV(external link) Auckland Regional HealthPathways (login required)
  2. Pregnancy and breastfeeding with HIV(external link) Health New Zealand | Te Whatu Ora

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Phoebe Hunt, Sexual Health Registrar, Northland

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