Preconception Care for HIV-Infected Women: Guideline and Commentary

Mary Jo Fink, MD


September 17, 2010

In This Article

Preconception Care for HIV-Infected Women: Expert Commentary

Pregnancy always involves decisions: "Do I want to have a baby and is this the best time in my life?" "Am I with a supportive partner?" "Am I, and is my partner, in optimal health to support a family?" These are questions that women ask of themselves and their care providers and in particular, these are questions women ask if they have a health condition.

Pregnancy may be planned or not. The mother may be healthy only to have a genetic predisposition or illness uncovered in the course of prenatal care. Or a woman with a transmissible condition like HIV may decide to become pregnant and ask what she can do to protect the baby from infection. These are the challenges that face those who care for women, especially women who are HIV-seropositive.

Standard of care practice has evolved over the past 15 years on the foundation of the initial findings in 1994 that azidothymidine (AZT) use in pregnancy dramatically decreased the likelihood of maternal to child transmission (MTCT). Antiretroviral (ARV) medications, coupled with consideration of elective C-section under certain conditions, has resulted in MTCT rates < 1% when the viral load is optimally suppressed. Thus the role of early maternal HIV detection and prevention of MTCT through preconception and antepartum counseling assumes central importance.

The New York State Department of Health AIDS Institute has released the document on Preconception Care for HIV-infected Women 1 (see next page) to guide women and care providers in this decision-making process. It is appropriate that the document begins with an emphasis on contraception in the context of options counseling, on prevention of sexually transmitted infection (STI) and HIV transmission, and on health promotion for all women of reproductive age. However, for this message to engage the patient, it is vital that the dialogue with the healthcare provider be respectful and consider the context of the patient's life and that of her defined family. A general question about the possible impact of a pregnancy, asked in an open-ended manner, can facilitate an honest discussion that reveals and clarifies a patient's values, which is central to both family planning and options counseling decisions. In choosing a contraceptive method, it is essential to recognize the adverse drug interactions with ARV medications that can have an impact on the effectiveness of hormonal contraceptive medications.

Despite appropriate counseling and best intentions, unintended pregnancy rates remain high in the United States, including in HIV-positive women.2 Therefore, a regular review of ARV medications, with avoidance of those that are contraindicated in pregnancy, is crucial. For patients who decide to maintain a pregnancy, an informed decision, weighing risks and benefits of ARV, is vital. Collaboration with obstetrical services can assure appropriate prenatal care and suppression of the viral load. Care providers should also be aware of regional referral services should the patient choose to terminate the pregnancy.

Effective medical treatment of HIV infection has changed the way women live their lives. They may choose to become pregnant with the knowledge that they are very likely to have a child who is not infected with HIV. Care providers of these patients assume a key role in coordinating medical, dental, and mental health services. Equally important is finding the key to the patient's acceptance of treatment for her sake and that of her unborn child.


  1. Women's Health Committee. Preconception Care for HIV-infected Women. New York State Department of Health AIDS Institute. July 2010. Available at Accessed September 7, 2010.

  2. Massad LS, Springer G, Jacobson L, et al. Pregnancy rates and predictors of conception, miscarriage, and abortion in US women with HIV. AIDS. 2004;18:281-286. Abstract


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