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HIV can pass from a mother to her child during pregnancy, childbirth or when breastfeeding.^{1 2 3 4}

If you're pregnant and have HIV infection, the virus can pass to your baby by crossing the placenta and passing through the umbilical cord.

If you don't take any treatments, there's about a 1 in 4 chance that your baby will be born with the virus.Taking antiretroviral drugs can greatly reduce the chance that your baby will get HIV. The exact amount of protection depends on the types of drugs you can take, and the levels of virus in your blood (your viral load).⁵

By having a cesarean section and not breastfeeding you can reduce the risk of your baby becoming infected with HIV by even more (see below).

If you're pregnant and have HIV but are not on antiretroviral treatment, you should be given drugs to slow down HIV late in your pregnancy (usually around 28 or 35 weeks).⁶ Your baby also should be given drug treatment for HIV soon after he or she is born.

If you are already taking antiretroviral treatment, you will continue taking this during the pregnancy, although your doctor may make some changes to the drugs you take. This is because certain drugs are thought to be safer and more effective if you're pregnant.

The risk of passing the virus on to your baby increases as the infection gets worse.^{1 4 7} If you have HIV, doctors keep track of your CD4 count. The lower your CD4 count, the worse your condition. If your CD4 count drops below a certain score, it means you have AIDS.

Babies may get infected with HIV during labor. You can lower the chances of this happening by having your baby by cesarean section rather than by vaginal delivery.⁸

One study shows that only 2 in 100 babies born by cesarean section were infected with HIV at 18 months. Of those who were born by vaginal delivery, 10 in 100 had the virus.⁸ About 6 out of 10 women in the study in both groups (cesarean and vaginal delivery) were also taking drugs to slow down HIV (antiretroviral drugs). The evidence so far suggests that babies born to women who take antiretroviral drugs and have their baby by cesarean section have a very low risk of becoming infected.But we need more research to be sure.

If you have HIV and you breastfeed your baby or feed your baby with your expressed breast milk, there's a chance that some virus in the milk could infect your baby.^{2 3 9} In one study in Kenya, 30 in 100 babies who were breastfed were HIV positive after 24 months.⁹ Out of those who were given formula milk, 15 in 100 were HIV positive. So if you have HIV, you should feed your baby with formula, not breast milk.⁶

Some doctors have thought that drugs that help the immune system (the parts of your body that help to fight infections) will reduce the chance of babies being infected with HIV from their mother. The drugs that have been used in studies are called HIV hyperimmune globulin and immunoglobulin. But so far these drugs have not been found to reduce the transmission of HIV to babies.¹⁰

One big review looked at whether giving vitamins to pregnant women would help stop their babies from getting the virus. It showed vitamins didn't help.¹¹

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.