Perinatal HIV transmission, also known as mother-to-child transmission, can happen at any time during pregnancy, labor, delivery, and breastfeeding. The CDC recommends that all women who are pregnant or planning to get pregnant have an HIV test as early as possible before and during every pregnancy. Early identification and treatment of HIV infection in pregnant women not only improves the health of the mother, but is the best way to prevent neonatal disease. The use of antiretroviral medications given to women with HIV during pregnancy and labor and to their newborns in the first hours after birth can reduce the rate of mother-to-child HIV transmission from 25% to less than 1%. Without treatment, approximately 1 in 4 exposed babies will be infected.
Even for women who are not treated during pregnancy, HIV transmission rates can be substantially decreased by instituting maternal therapy during labor and delivery and providing neonatal therapy after delivery. Women with viral loads greater than 1,000 copies per milliliter, whether or not they are on antiretroviral therapy, may benefit from Cesarean delivery that is performed before the onset of labor and before rupture of membranes.
The reduction in mother-to-child HIV transmission is a public health success story. Despite the successes, there still are too many HIV-positive babies being born in the U.S., with National estimates at approximately 200 infants infected via mother-to-child transmission per year.
It is important that all women who are pregnant or trying to get pregnant encourage their partners to also get tested for HIV. Women who are HIV-negative but have an HIV-positive partner should talk to their doctor about PrEP to protect themselves while trying to get pregnant, and to protect themselves and their baby during pregnancy and while breastfeeding.
This section includes information for ob-gyns and other women’s health providers on recommended HIV testing in pregnancy, state HIV testing requirements for pregnant women, provider tools and references, and resources for patients. Specific information on HIV and non-pregnant women is found in another section.