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HIV Medicines During Pregnancy and Childbirth

Last Reviewed: September 24, 2020

Key Points

  • All pregnant women with HIV should take HIV medicines during pregnancy for their own health and to prevent mother-to-child transmission of HIV. (HIV medicines are called antiretrovirals.)
  • Most HIV medicines are safe to use during pregnancy. In general, HIV medicines don’t increase the risk of birth defects.
  • In general, pregnant women with HIV can use the same HIV regimens recommended for non-pregnant adults—unless the risk of any known side effects to a pregnant woman or her baby outweighs the benefits of a regimen.
  • All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In most cases, women who are already on an effective HIV regimen when they become pregnant should continue using the same regimen throughout their pregnancies.
  • A scheduled cesarean delivery (sometimes called a C-section) to prevent mother-to-child transmission of HIV is recommended for women with high or unknown viral loads near the time of delivery. The C-section is scheduled for the 38th week of pregnancy (2 weeks before a woman’s expected due date).

Should women with HIV take HIV medicines during pregnancy?

Yes. All pregnant women with HIV should take HIV medicines during pregnancy for their own health and to prevent mother-to-child transmission of HIV. (HIV medicines are called antiretrovirals.) Mother-to-child transmission of HIV is also called perinatal transmission of HIV.

HIV medicines prevent HIV from multiplying, which reduces the amount of HIV in the body (called the viral load). An undetectable viral load is when the level of HIV in the blood is too low to be detected by a viral load test. The risk of mother-to-child transmission of HIV during pregnancy and childbirth is lowest when a woman with HIV has an undetectable viral load. Maintaining an undetectable viral load also helps keep the mother-to-be healthy.

Are HIV medicines safe to use during pregnancy?

Most HIV medicines are safe to use during pregnancy. In general, HIV medicines don’t increase the risk of birth defects.

When recommending HIV medicines to use during pregnancy, health care providers consider the benefits and risks of specific HIV medicines for women and their unborn babies.

When should pregnant women with HIV start taking HIV medicines?

All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In most cases, women who are already on an effective HIV regimen when they become pregnant should continue using the same regimen throughout their pregnancies.

What HIV medicines should a pregnant woman with HIV take?

The choice of an HIV regimen to use during pregnancy depends on several factors, including a woman’s current or past use of HIV medicines, other medical conditions she may have, and the results of drug resistance testing. In general, pregnant women with HIV can use the same HIV regimens recommended for non-pregnant adults—unless the risk of any known side effects to a pregnant woman or her baby outweighs the benefits of a regimen.

Sometimes a woman’s HIV regimen may change during pregnancy. Women and their health care providers should discuss whether any changes need to be made to an HIV regimen during pregnancy.

Do women with HIV continue to take HIV medicines during childbirth?

Yes. A baby is exposed to any HIV in the mother’s blood and other fluids while passing through the birth canal. During childbirth, HIV medicines that pass from mother to baby across the placenta prevent mother-to-child transmission of HIV, especially near delivery.

Women who are already taking HIV medicines when they go into labor should continue taking their HIV medicines on schedule as much as possible during childbirth.

Women who are not taking HIV medicines or who have a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery should receive an HIV medicine called zidovudine (brand name: Retrovir) by intravenous (IV) infusion.

Zidovudine passes easily from a pregnant woman to her unborn baby across the placenta. Once in a baby’s system, zidovudine protects the baby from any HIV that passes from mother to child during childbirth. For this reason, the use of zidovudine during childbirth prevents mother-to-child transmission of HIV even in women with high viral loads near the time of delivery.

Can a cesarean delivery reduce the risk of mother-to-child transmission of HIV?

Yes. A scheduled cesarean delivery (sometimes called a C-section) can reduce the risk of mother-to-child transmission of HIV in women who have a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery. A cesarean delivery to reduce the risk of mother-to-child transmission of HIV is scheduled for the 38th week of pregnancy, 2 weeks before a woman’s expected due date. 

A scheduled C-section to reduce the risk of mother-to-child transmission of HIV is not routinely recommended for women who are taking HIV medicines and have a viral load of 1,000 copies/mL or less. Of course, regardless of her viral load, a woman with HIV may have a C-section for other medical reasons.

With the help of their health care providers, women can decide which HIV medicines to use during childbirth and whether they should have a scheduled C-section to prevent mother-to-child transmission of HIV.

Do women with HIV continue to take HIV medicines after childbirth?

Prenatal care for women with HIV includes counseling on the benefits of continuing HIV medicines after childbirth. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission. Together with their health care providers, women with HIV make decisions about continuing or changing their HIV medicines after childbirth.

After birth, babies born to women with HIV receive HIV medicine to reduce the risk of mother-to-child transmission of HIV. Several factors determine what HIV medicine they receive and how long they receive the medicine. To learn more, read the ClinicalInfo fact sheet on Preventing Mother-to-Child Transmission of HIV After Birth.

This fact sheet is based on information from the following sources: