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HIV and pregnancy - Wikipedia

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id="toc-Testing_in_pregnancy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Testing_in_pregnancy"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Testing in pregnancy</span> </div> </a> <ul id="toc-Testing_in_pregnancy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment/management" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment/management"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatment/management</span> </div> </a> <button aria-controls="toc-Treatment/management-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment/management subsection</span> </button> <ul id="toc-Treatment/management-sublist" class="vector-toc-list"> <li id="toc-Prenatal_care" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Prenatal_care"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Prenatal care</span> </div> </a> <ul id="toc-Prenatal_care-sublist" class="vector-toc-list"> <li id="toc-Prevention_of_mother-to-child_transmission" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Prevention_of_mother-to-child_transmission"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.1</span> <span>Prevention of mother-to-child transmission</span> </div> </a> <ul id="toc-Prevention_of_mother-to-child_transmission-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Labor_and_delivery" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Labor_and_delivery"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.2</span> <span>Labor and delivery</span> </div> </a> <ul id="toc-Labor_and_delivery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunizations" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Immunizations"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.3</span> <span>Immunizations</span> </div> </a> <ul id="toc-Immunizations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_evaluation" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Further_evaluation"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.4</span> <span>Further evaluation</span> </div> </a> <ul id="toc-Further_evaluation-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Antiretroviral_medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antiretroviral_medications"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Antiretroviral medications</span> </div> </a> <ul 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class="vector-toc-numb">4.3</span> <span>Postnatal care</span> </div> </a> <ul id="toc-Postnatal_care-sublist" class="vector-toc-list"> <li id="toc-Maternal_follow-up" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Maternal_follow-up"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3.1</span> <span>Maternal follow-up</span> </div> </a> <ul id="toc-Maternal_follow-up-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Infant_Treatment_and_Follow-Up" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Infant_Treatment_and_Follow-Up"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3.2</span> <span>Infant Treatment and Follow-Up</span> </div> </a> <ul id="toc-Infant_Treatment_and_Follow-Up-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Breastfeeding" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Breastfeeding"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3.3</span> <span>Breastfeeding</span> </div> </a> <ul id="toc-Breastfeeding-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Societal_impacts" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Societal_impacts"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Societal impacts</span> </div> </a> <button aria-controls="toc-Societal_impacts-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Societal impacts subsection</span> </button> <ul id="toc-Societal_impacts-sublist" class="vector-toc-list"> <li id="toc-Discrimination" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Discrimination"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Discrimination</span> 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<span>Support groups</span> </div> </a> <ul id="toc-Support_groups-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> 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class="mw-page-title-main">HIV and pregnancy</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. 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data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Transmission_du_VIH_%C3%A0_l%27accouchement" title="Transmission du VIH à l&#039;accouchement – French" lang="fr" hreflang="fr" data-title="Transmission du VIH à l&#039;accouchement" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%9D%B8%EA%B0%84%EB%A9%B4%EC%97%AD%EA%B2%B0%ED%95%8D_%EB%B0%94%EC%9D%B4%EB%9F%AC%EC%8A%A4%EC%99%80_%EC%9E%84%EC%8B%A0" title="인간면역결핍 바이러스와 임신 – Korean" lang="ko" hreflang="ko" data-title="인간면역결핍 바이러스와 임신" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%84%D4%BB%D4%B1%D5%8E_%D6%87_%D5%B0%D5%B2%D5%AB%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6" title="ՄԻԱՎ և հղիություն – Armenian" lang="hy" hreflang="hy" data-title="ՄԻԱՎ և հղիություն" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%99%D7%A8%D7%99%D7%95%D7%9F_%D7%95-HIV" title="היריון ו-HIV – Hebrew" lang="he" hreflang="he" data-title="היריון ו-HIV" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/OIV_va_homiladorlik" title="OIV va homiladorlik – Uzbek" lang="uz" hreflang="uz" data-title="OIV va homiladorlik" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%92%D0%98%D0%A7_%D0%B8_%D0%B1%D0%B5%D1%80%D0%B5%D0%BC%D0%B5%D0%BD%D0%BD%D0%BE%D1%81%D1%82%D1%8C" title="ВИЧ и беременность – Russian" lang="ru" hreflang="ru" data-title="ВИЧ и беременность" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q3537721#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu vector-menu-tabs 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class="vector-pinnable-header-toggle-button vector-pinnable-header-unpin-button" data-event-name="pinnable-header.vector-appearance.unpin">hide</button> </div> </div> </div> </nav> </div> </div> <div id="bodyContent" class="vector-body" aria-labelledby="firstHeading" data-mw-ve-target-container> <div class="vector-body-before-content"> <div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">HIV transmission route</div> <p><b>HIV in pregnancy</b> is the presence of an <a href="/wiki/HIV/AIDS" title="HIV/AIDS">HIV/AIDS</a> infection in a woman while she is pregnant. There is a risk of <a href="/wiki/HIV" title="HIV">HIV</a> transmission from mother to child in three primary situations: <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>, <a href="/wiki/Childbirth" title="Childbirth">childbirth</a>, and while <a href="/wiki/Breastfeeding" title="Breastfeeding">breastfeeding</a>. This topic is important because the risk of <a href="/wiki/Virus" title="Virus">viral</a> transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">The Centers for Disease Control</a> (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection <i>in utero</i> who did not become infected and 244 exposed infants who did become infected.<sup id="cite_ref-CDC_HIV_Surveillence_1-0" class="reference"><a href="#cite_note-CDC_HIV_Surveillence-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> </p><p>The burden of the <a href="/wiki/Epidemiology_of_HIV/AIDS" title="Epidemiology of HIV/AIDS">HIV/AIDS pandemic</a>, including mother-to-child transmission of HIV, disproportionately affects <a href="/wiki/Low_and_middle_income_countries" class="mw-redirect" title="Low and middle income countries">low- and middle-income countries</a>, in particular the countries of Southern Africa.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">&#91;</span>2<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/World_Health_Organization" title="World Health Organization">The World Health Organization</a> (WHO) estimates that 1.3 million women and girls living with HIV become pregnant each year.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">&#91;</span>3<span class="cite-bracket">&#93;</span></a></sup> </p><p>The risks of both neonatal HIV infection and maternal illness are reduced by appropriate prenatal screening, treatment of the HIV infection with <a href="/wiki/Management_of_HIV/AIDS" title="Management of HIV/AIDS">antiretroviral therapy</a> (ART), and adherence to recommendations after birth. Notably, without antiretroviral medications, obstetrical interventions, and breastfeeding recommendations, there is approximately a 30% risk of mother-to-child HIV transmission.<sup id="cite_ref-Workowski_2015_4-0" class="reference"><a href="#cite_note-Workowski_2015-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> This risk is reduced to less than 1% when the previously mentioned interventions are employed.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup> The American College of Obstetrics and Gynecology (ACOG) therefore recommends HIV testing as a routine component of both pre-pregnancy and first trimester prenatal care to ensure expedient and appropriate interventions.<sup id="cite_ref-ACOG_2018_6-0" class="reference"><a href="#cite_note-ACOG_2018-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup> </p><p>HIV infection is not a <a href="/wiki/Contraindication" title="Contraindication">contraindication</a> to pregnancy. Women with HIV may choose to become pregnant if they so desire, however, they are encouraged to talk with their doctors beforehand. Notably, 20-34% of women in the United States living with HIV are unaware of their diagnosis until they become pregnant and undergo prenatal screening.<sup id="cite_ref-OAR_Clinical_Info_7-0" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Mechanism_of_transmission">Mechanism of transmission</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=1" title="Edit section: Mechanism of transmission"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>HIV can be transmitted from an infected mother to the neonate in three circumstances: across the placenta during pregnancy (<i>in utero)</i>, at birth due to fetal contact with infected maternal genital secretions and blood, or postnatally through the breast milk.<sup id="cite_ref-Levinson_2020_8-0" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup> This type of viral transmission is also known of as <a href="/wiki/Vertically_transmitted_infection" title="Vertically transmitted infection">vertical transmission</a>. It is thought that mother-to-child HIV transmission most commonly occurs at the time of delivery when the baby comes into direct contact with the mother's infected blood or genital secretions/fluid in the birth canal.<sup id="cite_ref-Levinson_2020_8-1" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup> Maternal treatment with ART therapy prior to delivery decreases the <a href="/wiki/Viral_load" title="Viral load">viral load</a>, or the amount of virus present in the mother's blood and other body fluids, which significantly reduces the chance of viral transmission to the fetus during labor.<sup id="cite_ref-Levinson_2020_8-2" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Signs_or_symptoms">Signs or symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=2" title="Edit section: Signs or symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Maternal">Maternal</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=3" title="Edit section: Maternal"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>HIV infections in adults typically follow a 3-stage course, as described below: </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Cross_Reaction_Rash_cropped.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/97/Cross_Reaction_Rash_cropped.jpg/220px-Cross_Reaction_Rash_cropped.jpg" decoding="async" width="220" height="240" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/97/Cross_Reaction_Rash_cropped.jpg/330px-Cross_Reaction_Rash_cropped.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/97/Cross_Reaction_Rash_cropped.jpg/440px-Cross_Reaction_Rash_cropped.jpg 2x" data-file-width="519" data-file-height="567" /></a><figcaption>Maculopapular Rash, <i>note: this image shows a nonspecific rash that is not necessarily associated with an acute HIV infection</i></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Early_Symptoms_of_HIV_Diagram.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/75/Early_Symptoms_of_HIV_Diagram.png/220px-Early_Symptoms_of_HIV_Diagram.png" decoding="async" width="220" height="218" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/75/Early_Symptoms_of_HIV_Diagram.png/330px-Early_Symptoms_of_HIV_Diagram.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/75/Early_Symptoms_of_HIV_Diagram.png/440px-Early_Symptoms_of_HIV_Diagram.png 2x" data-file-width="703" data-file-height="697" /></a><figcaption>Early Symptoms of HIV Diagram.</figcaption></figure> <dl><dt>Early, acute stage</dt> <dd>The early stage of an HIV infection involves rapid viral replication and infection.<sup id="cite_ref-CDC_About_Hiv_9-0" class="reference"><a href="#cite_note-CDC_About_Hiv-9"><span class="cite-bracket">&#91;</span>9<span class="cite-bracket">&#93;</span></a></sup> This stage typically lasts for 2–4 weeks following an infection and subsequently resolves spontaneously. Between 50 and 90% of adults experience symptoms during this phase of infection.<sup id="cite_ref-Levinson_2020_8-3" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">&#91;</span>10<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-AAP_2018_11-0" class="reference"><a href="#cite_note-AAP_2018-11"><span class="cite-bracket">&#91;</span>11<span class="cite-bracket">&#93;</span></a></sup> At this time, women can experience fever, sore throat, lethargy, swollen lymph nodes, diarrhea, and a rash. The rash is described as maculopapular, which means it is composed of flat and raised skin lesions, and it appears on the trunk, arms and legs but does not appear on the palms of the hands or sole of the feet.<sup id="cite_ref-Levinson_2020_8-4" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup></dd> <dt>Middle, chronic/latent stage</dt> <dd>The middle stage of an HIV infection can last for 7–10 years in a patient who is not being treated with ART therapy.<sup id="cite_ref-Levinson_2020_8-5" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup> During this time, the virus itself is not latent or inactive, but it is sequestered inside of the lymph nodes, where it is replicating at low levels.<sup id="cite_ref-CDC_About_Hiv_9-1" class="reference"><a href="#cite_note-CDC_About_Hiv-9"><span class="cite-bracket">&#91;</span>9<span class="cite-bracket">&#93;</span></a></sup> Women are generally asymptomatic during this period but some can experience persistent fevers, fatigue, weight loss, and swollen lymph nodes, which is known as the AIDS-related complex (ARC).<sup id="cite_ref-Levinson_2020_8-6" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup></dd> <dt>Late, advanced/immunodeficient stage</dt> <dd>AIDS is caused by the progressive destruction of CD4 <a href="/wiki/T-helper_cells" class="mw-redirect" title="T-helper cells">T-helper cells</a> of the immune system by the HIV virus. AIDS is defined by either a CD4 cell count of less than 200 cells per microliter (which is indicative of severe immunodeficiency), or the development of an AIDS-specific condition.<sup id="cite_ref-CDC_About_Hiv_9-2" class="reference"><a href="#cite_note-CDC_About_Hiv-9"><span class="cite-bracket">&#91;</span>9<span class="cite-bracket">&#93;</span></a></sup> Because they are immunocompromised, women in this stage are at risk for serious, <a href="/wiki/Opportunistic_infections" class="mw-redirect" title="Opportunistic infections">opportunistic infections</a> that the general population either does not contract or contracts very mildly. These types of infections cause significant illness and death in patients with HIV/AIDS.<sup id="cite_ref-CDC_HIV_Surveillence_1-1" class="reference"><a href="#cite_note-CDC_HIV_Surveillence-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> People with such advanced HIV infections are also at greater risk for developing neurological symptoms (for example <a href="/wiki/HIV-associated_neurocognitive_disorder" title="HIV-associated neurocognitive disorder">dementia</a> and <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">neuropathy</a>), and certain cancers (for example <a href="/wiki/Non-Hodgkin%27s_Lymphoma" class="mw-redirect" title="Non-Hodgkin&#39;s Lymphoma">Non-Hodgkin's B-Cell Lymphoma</a>, <a href="/wiki/Kaposi%27s_sarcoma" title="Kaposi&#39;s sarcoma">Kaposi's Sarcoma</a>, and <a href="/wiki/Human_papillomavirus_infection" title="Human papillomavirus infection">HPV</a>-associated cancers including <a href="/wiki/Anal_cancer" title="Anal cancer">anal</a>, <a href="/wiki/Cervical_cancer" title="Cervical cancer">cervical</a>, <a href="/wiki/Head_and_neck_cancer" title="Head and neck cancer">oral, pharyngeal</a>, <a href="/wiki/Penile_cancer" title="Penile cancer">penile</a> and <a href="/wiki/Vulvar_cancer" title="Vulvar cancer">vulvar cancer</a>).<sup id="cite_ref-Levinson_2020_8-7" class="reference"><a href="#cite_note-Levinson_2020-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup></dd></dl> <div class="mw-heading mw-heading3"><h3 id="Infant">Infant</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=4" title="Edit section: Infant"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Human_tongue_infected_with_oral_candidiasis.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a0/Human_tongue_infected_with_oral_candidiasis.jpg/220px-Human_tongue_infected_with_oral_candidiasis.jpg" decoding="async" width="220" height="286" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a0/Human_tongue_infected_with_oral_candidiasis.jpg/330px-Human_tongue_infected_with_oral_candidiasis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a0/Human_tongue_infected_with_oral_candidiasis.jpg/440px-Human_tongue_infected_with_oral_candidiasis.jpg 2x" data-file-width="1934" data-file-height="2513" /></a><figcaption>Oral Candidiasis (oral thrush) in a child.</figcaption></figure> <p>The clinical presentation of HIV in untreated infants is less predictable and specific than that of an adult infection. Notably, if an HIV diagnosis is diagnosed and appropriately treated, symptoms and complications in the infant are rare. Without ART therapy, infants born with HIV have a poor prognosis. If symptoms develop, the most common include persistent fevers, generalized lymph node swelling, enlarged spleen and/or liver, growth failure, and diarrhea. These children can also develop <a href="/wiki/Opportunistic_infection" title="Opportunistic infection">opportunistic infections</a>, notably including recurrent oral thrush (<a href="/wiki/Candidiasis" title="Candidiasis">Candidiasis</a>) and/or Candida diaper rash, <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a>, or invasive bacterial, viral, parasitic, or fungal infections. Neurologic symptoms, particularly <a href="/wiki/HIV-associated_neurocognitive_disorder" title="HIV-associated neurocognitive disorder">HIV encephalopathy</a>, are common in infants with untreated HIV.<sup id="cite_ref-AAP_2018_11-1" class="reference"><a href="#cite_note-AAP_2018-11"><span class="cite-bracket">&#91;</span>11<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis/screening"><span id="Diagnosis.2Fscreening"></span>Diagnosis/screening</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=5" title="Edit section: Diagnosis/screening"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Pregnancy_planning">Pregnancy planning</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=6" title="Edit section: Pregnancy planning"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The main factors to consider in pregnancy planning for HIV positive individuals are the risk of disease transmission between the sexual partners themselves and the risk of disease transmission to the fetus. Both risks can be mitigated with appropriate perinatal planning and preventative care.<sup id="cite_ref-:21_12-0" class="reference"><a href="#cite_note-:21-12"><span class="cite-bracket">&#91;</span>12<span class="cite-bracket">&#93;</span></a></sup> </p><p>ACOG and the National Institutes of Health (NIH) recommends all couples in which one or both partners are HIV positive seek pre-pregnancy counseling and consult experts in Obstetrics and Gynecology, Infectious Disease, and possibly reproductive endocrinology and infertility to ensure couples are getting appropriate, individualized guidance based on their specific disease states and weighing the risks to the fetus associated with taking ART medications.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">&#91;</span>13<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:14_14-0" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> </p><p>Couples in which only one partner is HIV positive are at risk of transmitting HIV to the uninfected partner. These couples are known as <a href="/wiki/Serodiscordant" title="Serodiscordant">serodiscordant</a> couples. The CDC reports that HIV positive people who are able to sustain undetectable viral loads while taking ART therapy have a negligible risk of transmitting HIV to their partner through sex based on observational data from multiple large scale studies, most notably the <a href="/wiki/HPTN_052" title="HPTN 052">HPTN052 clinical trial</a>, the PARTNER study, the PARTNER2 study, and the Opposites Attract Study.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">&#91;</span>15<span class="cite-bracket">&#93;</span></a></sup> The NIH therefore advises that HIV positive people who maintain an undetectable viral load via adherence to long-term ART therapy can attempt conception via condomless sex with minimal risk of disease transmission to the HIV negative partner.<sup id="cite_ref-:14_14-1" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> The NIH further recommends that aligning condomless sex with peak fertility, which occurs at ovulation, via ovulation test kits and consultation with clinical experts can maximize the chance for conception.<sup id="cite_ref-:14_14-2" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:In_vitro_fertilization.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e9/In_vitro_fertilization.jpg/220px-In_vitro_fertilization.jpg" decoding="async" width="220" height="177" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e9/In_vitro_fertilization.jpg/330px-In_vitro_fertilization.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e9/In_vitro_fertilization.jpg/440px-In_vitro_fertilization.jpg 2x" data-file-width="720" data-file-height="578" /></a><figcaption>In-Vitro Fertilization.</figcaption></figure> <p>When the HIV positive individual in a serodiscordant partnership has not achieved viral suppression or his or her viral status is unknown, there are other options for preventing transmission amongst partners. The first option includes administering <a href="/wiki/Pre-exposure_prophylaxis" title="Pre-exposure prophylaxis">Pre-Exposure Prophylaxis ART Therapy (PrEP)</a> to the HIV negative partner, which involves once daily dosing of a combination drug to prevent the transmission of HIV following condomless sex.<sup id="cite_ref-:14_14-3" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> The NIH advises administering PrEP to serodiscordant couples who are going to attempt conception via condomless sex, however, they emphasize that adherence is absolutely necessary to effectively protect the HIV negative partner.<sup id="cite_ref-:14_14-4" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> The other option for achieving conception while simultaneously preventing HIV transmission amongst partners is reproductive assistance. When the female attempting to conceive is HIV positive, she can undergo assisted insemination with semen from her partner to reduce the risk of transmission.<sup id="cite_ref-:14_14-5" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> When the man in the partnership is HIV positive, the couple can choose to use donor sperm or utilize sperm preparation techniques (for example, <a href="/wiki/Sperm_washing" title="Sperm washing">sperm washing</a> and subsequent viral testing of the sample) and intrauterine or <a href="/wiki/In_vitro_fertilisation" title="In vitro fertilisation"><i>in vitro</i> fertilization</a> to achieve conception to reduce the risk of transmission to his partner.<sup id="cite_ref-:14_14-6" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> </p><p>In couples where the male and female are both HIV positive, conception may occur normally without concern for disease transmission amongst each other. However, it is vital for any HIV positive mother to initiate and maintain appropriate ART therapy under the guidance of an HIV expert prior to and throughout pregnancy to reduce the risk of perinatal transmission to the fetus.<sup id="cite_ref-:14_14-7" class="reference"><a href="#cite_note-:14-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> </p><p>Although assisted reproductive techniques are available for serodiscordant couples, there are still limitations to achieving a successful pregnancy. women with HIV have been shown to have decreased fertility, which can affect the available reproductive options.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">&#91;</span>16<span class="cite-bracket">&#93;</span></a></sup> women with HIV are also more likely to be infected with other sexually transmitted diseases, placing them at higher risk for infertility. Males with HIV appear to have decreased semen volume and sperm motility, which decreases their fertility.<sup id="cite_ref-:02_17-0" class="reference"><a href="#cite_note-:02-17"><span class="cite-bracket">&#91;</span>17<span class="cite-bracket">&#93;</span></a></sup> ART may also affect both male and female fertility and some drugs can be <a href="/wiki/Teratogen" class="mw-redirect" title="Teratogen">toxic</a> to embryos.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">&#91;</span>18<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Testing_in_pregnancy">Testing in pregnancy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=7" title="Edit section: Testing in pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Diagnosis_of_HIV/AIDS" title="Diagnosis of HIV/AIDS">Diagnosis of HIV/AIDS</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:HIV_Rapid_Test_being_administered.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/76/HIV_Rapid_Test_being_administered.jpg/220px-HIV_Rapid_Test_being_administered.jpg" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/76/HIV_Rapid_Test_being_administered.jpg/330px-HIV_Rapid_Test_being_administered.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/76/HIV_Rapid_Test_being_administered.jpg/440px-HIV_Rapid_Test_being_administered.jpg 2x" data-file-width="2448" data-file-height="3264" /></a><figcaption>HIV Rapid Test being administered to a patient.</figcaption></figure> <p>Early identification of maternal HIV infection and initiation of ART in pregnancy is vital in preventing viral transmission to the fetus and protecting maternal health, as HIV-infected women who do not receive testing are more likely to transmit the infection to their children.<sup id="cite_ref-ACOG_2018_6-1" class="reference"><a href="#cite_note-ACOG_2018-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-CDC_Opt_Out_19-0" class="reference"><a href="#cite_note-CDC_Opt_Out-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> The CDC, NIH, ACOG, and American Academy of Pediatrics each recommend first trimester <a href="/wiki/Diagnosis_of_HIV/AIDS" title="Diagnosis of HIV/AIDS">HIV testing</a> for all pregnant women as a part of routine prenatal care.<sup id="cite_ref-OAR_Clinical_Info_7-1" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-CDC_HIV_Surveillence_1-2" class="reference"><a href="#cite_note-CDC_HIV_Surveillence-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> The NIH further elaborates on this recommendation, indicating that HIV testing should be conducted as early as possible wherever a woman seeks care and initially determines she is pregnant (for example, in the Emergency Department).<sup id="cite_ref-OAR_Clinical_Info_7-2" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup> First trimester HIV testing is conducted simultaneously with other routine, early pregnancy lab work in the United States, including: a complete blood count, blood typing and Rhesus factor, urinalysis, urine culture, rubella titer, hepatitis B and C titers, sexually transmitted infection testing, and tuberculosis testing.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">&#91;</span>20<span class="cite-bracket">&#93;</span></a></sup> ACOG advises that prenatal caregivers repeat third trimester HIV testing prior to 36 weeks gestation for the following women: those who remain at high risk for contracting an HIV infection, those who reside in areas with a high incidence of HIV infection in pregnancy, those who are incarcerated, or those with symptoms suggestive of an acute HIV infection.<sup id="cite_ref-ACOG_2018_6-2" class="reference"><a href="#cite_note-ACOG_2018-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup> For women who have not received prenatal care or who have not been previously tested for HIV infection during pregnancy, ACOG and the NIH suggest performing rapid HIV screening in the labor and delivery unit prior to delivery or immediately postpartum.<sup id="cite_ref-ACOG_2018_6-3" class="reference"><a href="#cite_note-ACOG_2018-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-OAR_Clinical_Info_7-3" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup> </p><p>HIV testing in the United States is currently offered on an <i>opt-out</i> basis, per the CDC's recommendation.<sup id="cite_ref-CDC_Opt_Out_19-1" class="reference"><a href="#cite_note-CDC_Opt_Out-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> <i>Opt-out</i> testing involves educating the patient on the impact of an HIV infection on pregnancy, notifying the patient that HIV screening is recommended for all pregnant women, and informing her that she will automatically receive the test with her other routine lab work unless she explicitly declines the test and signs a consent form to have it removed from her lab panel.<sup id="cite_ref-ACOG_2018_6-4" class="reference"><a href="#cite_note-ACOG_2018-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup> The alternative model, known as the <i>opt-in</i> model, involves counseling women on HIV testing, following which they elect to receive the test by signing a consent form. The <i>opt-in</i> model is not recommended by the CDC, as it is associated with lower testing rates.<sup id="cite_ref-OAR_Clinical_Info_7-4" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup> </p><p>If a woman chooses to decline testing, she will not receive the test. However, she will continue to receive HIV counseling throughout pregnancy so that she may be as informed as possible about the disease and its potential impact. She will be offered HIV testing at all stages of her pregnancy in case she changes her mind.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">&#91;</span>21<span class="cite-bracket">&#93;</span></a></sup> </p><p>The most updated HIV testing protocols recommend using the HIV-1 and HIV-2 antigen/antibody combination immunoassay as the initial screening test for an HIV infection.<sup id="cite_ref-Branson14_22-0" class="reference"><a href="#cite_note-Branson14-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup> This blood test assesses whether or not the mother has created <a href="/wiki/Antibody" title="Antibody">antibodies</a>, which are disease-fighting proteins of the immune system, against the HIV-1 and HIV-2 viruses. These antibodies will only be present if the patient has been exposed to HIV, therefore, they act as a marker of infection. This test also detects a protein called p24 in maternal blood, which is a specific component of the HIV virus itself and also acts as an early marker of an HIV infection. If this test is positive, the CDC recommends performing follow-up testing using a test called the HIV-1/HIV-2 antibody differentiation immunoassay that both confirms the diagnosis and determines the specific type of HIV infection the patient has to specifically tailor further management of the patient.<sup id="cite_ref-Branson14_22-1" class="reference"><a href="#cite_note-Branson14-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup> </p><p>Sometimes, however, a person may be infected with HIV but the body has not produced enough antibodies to be detected by the test.<sup id="cite_ref-OAR_Clinical_Info_7-5" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup> If a woman has risk factors for HIV infection or symptoms of an acute infection but tests negative on the initial screening test, she should be retested in 3 months to confirm that she does not have HIV, or she should receive further testing with an HIV RNA assay, which can be positive earlier than the antibody/antigen immunoassay.<sup id="cite_ref-OAR_Clinical_Info_7-6" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:22_23-0" class="reference"><a href="#cite_note-:22-23"><span class="cite-bracket">&#91;</span>23<span class="cite-bracket">&#93;</span></a></sup> Antiretroviral medications should be initiated at the time of maternal HIV diagnosis and they should be continued indefinitely.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">&#91;</span>24<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment/management"><span id="Treatment.2Fmanagement"></span>Treatment/management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=8" title="Edit section: Treatment/management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Prenatal_care">Prenatal care</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=9" title="Edit section: Prenatal care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading4"><h4 id="Prevention_of_mother-to-child_transmission">Prevention of mother-to-child transmission</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=10" title="Edit section: Prevention of mother-to-child transmission"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The risk of HIV transmission from mother to child is most directly related to the plasma <a href="/wiki/Viral_load" title="Viral load">viral load</a> of the mother. Untreated mothers with a high (HIV RNA greater than 100,000 copies/mL) have a transmission risk of over 50%.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">&#91;</span>25<span class="cite-bracket">&#93;</span></a></sup> For women with a lower viral load (HIV RNA less than 1000 copies/mL), the risk of transmission is less than 1%.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">&#91;</span>26<span class="cite-bracket">&#93;</span></a></sup> In general, the lower the viral load, the lower the risk of transmission. For this reason, ART is recommended throughout the pregnancy so that viral load levels remain as low as possible and the risk of transmission is reduced.<sup id="cite_ref-OAR_Clinical_Info_7-7" class="reference"><a href="#cite_note-OAR_Clinical_Info-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:1_27-0" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup> The usage of ART drugs that effectively cross the placenta can also act as <a href="/wiki/Pre-exposure_prophylaxis" title="Pre-exposure prophylaxis">pre-exposure prophylaxis</a> for the infant, as they can achieve adequate ART drug levels in the fetus to prevent acquisition of the viral illness.<sup id="cite_ref-:1_27-1" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup> Finally, it is recommended that ART drugs be administered to the infant following birth to continue to provide protection from the virus that the infant could have been exposed to during labor and delivery.<sup id="cite_ref-:1_27-2" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">&#91;</span>28<span class="cite-bracket">&#93;</span></a></sup> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Antiretroviral_Therapy_for_HIV_Infection_(27423001115).png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Antiretroviral_Therapy_for_HIV_Infection_%2827423001115%29.png/220px-Antiretroviral_Therapy_for_HIV_Infection_%2827423001115%29.png" decoding="async" width="220" height="110" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Antiretroviral_Therapy_for_HIV_Infection_%2827423001115%29.png/330px-Antiretroviral_Therapy_for_HIV_Infection_%2827423001115%29.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Antiretroviral_Therapy_for_HIV_Infection_%2827423001115%29.png/440px-Antiretroviral_Therapy_for_HIV_Infection_%2827423001115%29.png 2x" data-file-width="2049" data-file-height="1025" /></a><figcaption>Modern-day antiretroviral therapy</figcaption></figure> <p>All pregnant women who test positive for HIV should begin and continue ART therapy regardless of CD4 counts or viral load to reduce the risk of viral transmission.<sup id="cite_ref-:1_27-3" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup> The earlier ART is initiated, the more likely the viral load will be suppressed by the time of delivery.<sup id="cite_ref-:1_27-4" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">&#91;</span>29<span class="cite-bracket">&#93;</span></a></sup> Some women are concerned about using ART early in the pregnancy, as babies are most susceptible to drug toxicities during the first trimester. However, delaying ART initiation may be less effective in reducing infection transmission.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">&#91;</span>30<span class="cite-bracket">&#93;</span></a></sup> </p><p><a href="/wiki/Antiretroviral_therapy" class="mw-redirect" title="Antiretroviral therapy">Antiretroviral therapy</a> is most importantly used at the following times in pregnancy to reduce the risk of mother-to-child transmission of HIV: </p> <ul><li><i>During pregnancy:</i> pregnant women infected with HIV receive an oral regimen of at least three different anti-HIV medications.<sup id="cite_ref-aidsinfo2012_31-0" class="reference"><a href="#cite_note-aidsinfo2012-31"><span class="cite-bracket">&#91;</span>31<span class="cite-bracket">&#93;</span></a></sup></li> <li><i>During labor and delivery:</i> pregnant women infected with HIV who are already on triple ART should continue with their oral regimen. If their viral load is high (HIV RNA greater than 1,000 copies/mL), or there is question about whether medications have been taken consistently, then <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">intravenous</a> <a href="/wiki/Zidovudine" title="Zidovudine">zidovudine</a> (AZT) is added at the time of delivery.<sup id="cite_ref-lvguidelines_32-0" class="reference"><a href="#cite_note-lvguidelines-32"><span class="cite-bracket">&#91;</span>32<span class="cite-bracket">&#93;</span></a></sup> Pregnant women who have not been on ART prior to delivery or who have been on ART for less than four weeks should also be given intravenous AZT or a single dose of <a href="/wiki/Nevirapine" title="Nevirapine">nevirapin</a> (sdNVP), tenofovir (TDF) and emtricitabine (FTC) and a three-hourly dose of AZT.<sup id="cite_ref-:10_33-0" class="reference"><a href="#cite_note-:10-33"><span class="cite-bracket">&#91;</span>33<span class="cite-bracket">&#93;</span></a></sup></li></ul> <p>According to current recommendations by the WHO, CDC and U.S. Department of Health and Human Services (DHHS), all individuals with HIV should begin ART as soon as they are diagnosed with HIV. The recommendation is stronger in the following situations:<sup id="cite_ref-:4_34-0" class="reference"><a href="#cite_note-:4-34"><span class="cite-bracket">&#91;</span>34<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li><a href="/wiki/CD4_count" class="mw-redirect" title="CD4 count">CD4 count</a> below 350 cells/mm<sup>3</sup></li> <li>High viral load (HIV RNA greater than 100,000 copies/mL)</li> <li>Progression of HIV to AIDS</li> <li>Development of HIV-related infections and illnesses</li> <li>Pregnancy</li></ul> <div class="mw-heading mw-heading4"><h4 id="Labor_and_delivery">Labor and delivery</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=11" title="Edit section: Labor and delivery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Women should continue taking their ART regimen on schedule and as prescribed throughout both the prenatal period and childbirth. The viral load helps determine which mode of delivery is safest for both the mother and the baby.<sup id="cite_ref-:8_35-0" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p><p>According to the NIH, when the mother has been receiving ART and her viral load is low (HIV RNA less than 1000 copies/mL) at the time of delivery, the risk of viral transmission during childbirth is very low and a <a href="/wiki/Vaginal_delivery" title="Vaginal delivery">vaginal delivery</a> may be performed. A <a href="/wiki/Cesarean_delivery" class="mw-redirect" title="Cesarean delivery">cesarean delivery</a> or <a href="/wiki/Induction_of_labor" class="mw-redirect" title="Induction of labor">induction of labor</a> should only be performed in this patient population if they are medically necessary for non-HIV-related reasons.<sup id="cite_ref-:8_35-1" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p><p>If the maternal viral load is high (HIV RNA greater than 1000 copies/mL) or if her HIV viral load is unknown around the time of delivery (more than 34 weeks gestation), it is appropriate to schedule a cesarean delivery at 38 weeks to reduce the risk of HIV transmission during childbirth. In these situations, this is the appropriate management guideline regardless of whether or not the mother has taken prenatal ART.<sup id="cite_ref-:8_35-2" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p><p>Sometimes, women who have a high viral load who should receive a caesarean delivery will present to the hospital when their <a href="/wiki/Ruptured_membranes" class="mw-redirect" title="Ruptured membranes">water breaks</a> or they are in labor, and management for these patients is specific to each patient and will be determined at the time of presentation, as a cesarean delivery may not significantly reduce the risk of infection transmission.<sup id="cite_ref-:8_35-3" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> The NIH recommends that healthcare providers in the United States contact the National Perinatal HIV/AIDS Clinical Consultation Center at 1-888-448-8765 for further recommendations in these situations.<sup id="cite_ref-:8_35-4" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p><p>All women who present to the hospital in labor and their HIV status is unknown or they are at high risk of contracting an HIV infection but have not received repeat third trimester testing should be tested for HIV using a rapid HIV antigen/antibody test.<sup id="cite_ref-:8_35-5" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> If the rapid screening is positive, <a href="/wiki/Intravenous" class="mw-redirect" title="Intravenous">intravenous</a> (IV) zidovudine should be initiated in the mother immediately and further confirmatory testing should be performed.<sup id="cite_ref-:8_35-6" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p><p>IV <a href="/wiki/Zidovudine" title="Zidovudine">Zidovudine</a> is an antiretroviral drug that should be administered to women at or near the time of delivery in the following situations:<sup id="cite_ref-:8_35-7" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li>High viral load (HIV RNA greater than 1000 copies/mL)</li> <li>Unknown viral load</li> <li>Clinical suspicion for maternal noncompliance with prenatal ART regimen</li> <li>Positive rapid HIV antigen/antibody test at labor or prior to a scheduled caesarean delivery</li></ul> <p>Administration of IV Zidovudine can be considered on a case-by-case basis for women who have a moderate viral load (HIV RNA greater than or equal to 50 copies/mL AND less than 1000 copies/mL) near the time of delivery. IV Zidovudine is only not administered if women are <i>both</i> compliant with their prescribed ART regimen throughout pregnancy <i>and</i> have maintained a low viral load near the time of delivery (HIV RNA less than 50 copies/mL between 34 and 36 weeks gestation). </p><p>Further considerations for managing HIV positive women during labor and delivery include the following recommendations to reduce the risk of HIV transmission:<sup id="cite_ref-:8_35-8" class="reference"><a href="#cite_note-:8-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li>Avoid fetal scalp electrodes for fetal monitoring, particularly if the maternal viral load is greater than 50 copies/mL.</li> <li>Avoid artificial rupture of membranes and <a href="/wiki/Operative_vaginal_delivery" title="Operative vaginal delivery">operative vaginal delivery</a> (using forceps or a vacuum extractor) if at all possible, particularly in women who have not achieved viral suppression. If these methods need to be employed, they should be conducted carefully and following obstetric standards.</li> <li>The potential interactions between the specific ART drugs taken by the mother and those administered during labor should be considered by healthcare providers prior to drug administration.</li></ul> <div class="mw-heading mw-heading4"><h4 id="Immunizations">Immunizations</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=12" title="Edit section: Immunizations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>All pregnant women should receive the inactivated <a href="/wiki/Influenza_vaccine" title="Influenza vaccine">influenza vaccine</a> and the <a href="/wiki/DPT_vaccine" title="DPT vaccine">TdaP vaccine</a>, which covers <a href="/wiki/Tetanus" title="Tetanus">tetanus</a>, <a href="/wiki/Diphtheria" title="Diphtheria">diphtheria</a>, and <a href="/wiki/Whooping_cough" title="Whooping cough">pertussis</a> (whooping cough) during the first trimester, regardless of their HIV status.<sup id="cite_ref-:2_36-0" class="reference"><a href="#cite_note-:2-36"><span class="cite-bracket">&#91;</span>36<span class="cite-bracket">&#93;</span></a></sup> If a pregnant woman tests positive for HIV, she should also be administered the <a href="/wiki/Pneumococcal_vaccine" title="Pneumococcal vaccine">pneumococcal vaccine</a>, <a href="/wiki/Meningococcal_vaccine" title="Meningococcal vaccine">meningococcal vaccine</a>, and <a href="/wiki/Hepatitis_A_vaccine" title="Hepatitis A vaccine">Hepatitis A vaccine</a> and <a href="/wiki/Hepatitis_B_vaccine" title="Hepatitis B vaccine">Hepatitis B vaccine</a> following a conversation with her provider.<sup id="cite_ref-:2_36-1" class="reference"><a href="#cite_note-:2-36"><span class="cite-bracket">&#91;</span>36<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/Vaccination" title="Vaccination">Vaccination</a> is important to prevent serious infectious complications associated with the aforementioned diseases, which patients with HIV are at higher risk of contracting.<sup id="cite_ref-:2_36-2" class="reference"><a href="#cite_note-:2-36"><span class="cite-bracket">&#91;</span>36<span class="cite-bracket">&#93;</span></a></sup> </p><p>Pregnant women should notably not receive <a href="/wiki/Attenuated_vaccine" title="Attenuated vaccine">live vaccines</a>, including the Human papilloma virus <a href="/wiki/HPV_vaccine" title="HPV vaccine">(HPV) vaccine</a>, measles mumps and rubella <a href="/wiki/MMR_vaccine" title="MMR vaccine">(MMR) vaccine</a>, live influenza vaccine, and v<a href="/wiki/Varicella_vaccine" title="Varicella vaccine">aricella (Chicken pox) vaccine</a> regardless of their HIV statuses, as these vaccines can potentially harm the fetus.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">&#91;</span>37<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Further_evaluation">Further evaluation</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=13" title="Edit section: Further evaluation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The following monitoring tests are recommended for women who are diagnosed with HIV prior to or during pregnancy:<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">&#91;</span>38<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li><i><a href="/wiki/Viral_load" title="Viral load">HIV Viral Load</a></i> (via HIV RNA Levels) at the initial prenatal visit, 2–4 weeks after starting or changing ART, monthly until viral load is undetectable, at least every 3 months subsequently throughout pregnancy, and between 34 and 36 weeks to inform decisions regarding labor and delivery.</li> <li><i><a href="/wiki/CD4" title="CD4">CD4 Count</a></i> at the initial prenatal visit. This lab should be repeated every 3 months for pregnant women have been on ART for less than 2 years, have inconsistent ART compliance, CD4 counts less than 300 cells per millimeter cubed, or a high viral load. Otherwise, CD4 count does not need to be monitored following the initial visit.</li> <li><i>HIV <a href="/wiki/Drug_resistance" title="Drug resistance">Drug Resistance</a> Testing</i> should be performed prior to initiating ART in any pregnant woman including those who have and have not taken antiretroviral medications before, and when modifying failing ART regimens for pregnant women. Note, ART should be initiated <i>prior to</i> receiving the results of drug resistance testing.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">&#91;</span>39<span class="cite-bracket">&#93;</span></a></sup></li> <li><i>Standard Glucose Screening</i> to monitor for <a href="/wiki/Gestational_diabetes" title="Gestational diabetes">gestational diabetes</a>.</li> <li><i><a href="/wiki/Liver_function_tests" title="Liver function tests">Liver Function Tests</a></i> within 2–4 weeks after initiating or changing ART drugs and every 3 months subsequently.<sup id="cite_ref-:1_27-5" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup></li> <li>Monitoring for <i>ART Toxicities</i> based on the specific drugs that have been prescribed.</li> <li><i><a href="/wiki/Aneuploidy" title="Aneuploidy">Aneuploidy</a> Screening</i> should initially be offered via noninvasive methods. If these tests are abnormal or an abnormal ultrasound is performed, invasive testing via <a href="/wiki/Amniocentesis" title="Amniocentesis">amniocentesis</a> or <a href="/wiki/Chorionic_villus_sampling" title="Chorionic villus sampling">chorionic villus sampling</a> can be performed once an ART has been initiated and the HIV viral load is undetectable.</li> <li><i><a href="/wiki/Hepatitis" title="Hepatitis">Hepatitis</a> A, B, and C Screening</i> should be performed in all pregnant women with HIV because coinfection is common.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">&#91;</span>40<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:1_27-6" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup></li> <li>Further <a href="/wiki/Sexually_transmitted_infection" title="Sexually transmitted infection">S<i>exually Transmitted Infection</i></a> <i>(STI) Screening</i> should be performed as HIV positive women are at a higher risk for co-infection than the general population, and exposure to other STIs is associated with stillbirth, preterm delivery, low birth weight, and other complications. Screening should include syphilis, gonococcal, chlamydial, and trichomonal infection.<sup id="cite_ref-:1_27-7" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup></li> <li><i><a href="/wiki/Tuberculosis" title="Tuberculosis">Tuberculosis</a> Testing</i> as HIV positive patients are at high risk for developing active tuberculosis.<sup id="cite_ref-:1_27-8" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup></li> <li>Testing for prior <i><a href="/wiki/Toxoplasma_gondii" title="Toxoplasma gondii">Toxoplasma</a> Exposure</i> should be performed in HIV infected pregnant women, as reactivation of Toxoplasma gondii infection can occur with a low CD4 count (less than 100 cells per microliter), and has the potential to cause congenital toxoplasmosis in the fetus, which has many associated birth complications.<sup id="cite_ref-:1_27-9" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:16_41-0" class="reference"><a href="#cite_note-:16-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup></li> <li>Testing for <i><a href="/wiki/Cytomegalovirus" title="Cytomegalovirus">Cytomegalovirus</a> (CMV) Exposure</i> should similarly be performed, as CMV is the most common congenital infection and is associated with congenital hearing loss, major handicaps, and death in exposed infants.<sup id="cite_ref-:1_27-10" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:16_41-1" class="reference"><a href="#cite_note-:16-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Antiretroviral_medications">Antiretroviral medications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=14" title="Edit section: Antiretroviral medications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The goals of antiretroviral administration during pregnancy are to reduce the risk of transmission of HIV from mother to child, to slow maternal disease progression, and to reduce the risks of maternal opportunistic infection and death. It is important to choose medications that are as safe as possible for the mother and the fetus, and are effective at decreasing the total viral load. Certain antiretroviral drugs carry a risk of toxicity for the fetus. However, the overall benefits of an effective ART regimen outweigh the risks and all women are encouraged to use ART for the duration of their pregnancy.<sup id="cite_ref-:1_27-11" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">&#91;</span>42<span class="cite-bracket">&#93;</span></a></sup> It is important to note that the associations between birth defects and antiretroviral drugs are confounded by several important factors that could also contribute to these complications, for example: exposure to folate antagonists, nutritional and folate status, and tobacco, alcohol, and drug use during pregnancy.<sup id="cite_ref-:1_27-12" class="reference"><a href="#cite_note-:1-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup> </p><p>The recommended ART regimen for HIV-positive pregnant women is similar to that of the general population. In the United States, the favored ART regimen is a three-drug routine in which the first two drugs are NRTIs and the third is either a protease inhibitor, an integrase inhibitor, or an NNRTI.<sup id="cite_ref-:6_43-0" class="reference"><a href="#cite_note-:6-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li><a href="/wiki/Nucleoside_reverse_transcriptase_inhibitor" class="mw-redirect" title="Nucleoside reverse transcriptase inhibitor">Nucleoside reverse transcriptase inhibitors</a> (NRTIs) are considered the "backbone" of ART and 2 of these medications are generally used in combination. <ul><li>Due to its known safety profile and extensive use in pregnant patients, <a href="/wiki/Zidovudine" title="Zidovudine">zidovudine</a>-<a href="/wiki/Lamivudine" title="Lamivudine">lamivudine</a> is the preferred choice as the NRTI backbone. Zidovudine may worsen <a href="/wiki/Anemia" title="Anemia">anemia</a> so anemic patients are advised to use an alternative agent.</li> <li>For women who are coinfected with <a href="/wiki/Hepatitis_B" title="Hepatitis B">hepatitis B</a>, <a href="/wiki/Tenofovir" class="mw-redirect" title="Tenofovir">tenofovir</a> with either <a href="/wiki/Emtricitabine" title="Emtricitabine">emtricitabine</a> or <a href="/wiki/Lamivudine" title="Lamivudine">lamivudine</a> is the preferred NRTI backbone.<sup id="cite_ref-:6_43-1" class="reference"><a href="#cite_note-:6-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup></li> <li>NRTI use may cause a life-threatening complication called <a href="/wiki/Lactic_acidosis" title="Lactic acidosis">lactic acidosis</a> in some women, so it is important to monitor patients for this problem. Deaths from lactic acidosis and liver failure have been primarily associated with two specific NRTIs, <a href="/wiki/Stavudine" title="Stavudine">stavudine</a> and <a href="/wiki/Didanosine" title="Didanosine">didanosine</a>. Therefore, combinations involving these drugs should be avoided in pregnancy.<sup id="cite_ref-aidsinfo2012_31-1" class="reference"><a href="#cite_note-aidsinfo2012-31"><span class="cite-bracket">&#91;</span>31<span class="cite-bracket">&#93;</span></a></sup></li></ul></li> <li><a href="/wiki/Protease_inhibitor_(pharmacology)" title="Protease inhibitor (pharmacology)">Protease inhibitors</a> (PIs) have been studied extensively in pregnancy and are therefore the preferred third drug in the regimen. <a href="/wiki/Atazanavir" title="Atazanavir">Atazanavir</a>-<a href="/wiki/Ritonavir" title="Ritonavir">ritonavir</a> and <a href="/wiki/Darunavir" title="Darunavir">darunavir</a>-ritonavir are two of the most common PIs used during pregnancy. <ul><li>There is conflicting data regarding the association between protease inhibitors with preterm births. Boosted <a href="/wiki/Lopinavir" title="Lopinavir">lopinavir</a> has the strongest correlation with this outcome, so women who are at a high risk for premature delivery are advised not to use this drug.<sup id="cite_ref-:17_44-0" class="reference"><a href="#cite_note-:17-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup></li> <li>Some PIs have been associated with high blood sugar (<a href="/wiki/Hyperglycemia" title="Hyperglycemia">hyperglycemia</a>) but is unclear whether or not they contribute to the development of <a href="/wiki/Gestational_diabetes" title="Gestational diabetes">gestational diabetes</a>.<sup id="cite_ref-aidsinfo2012_31-2" class="reference"><a href="#cite_note-aidsinfo2012-31"><span class="cite-bracket">&#91;</span>31<span class="cite-bracket">&#93;</span></a></sup></li> <li>Some PIs have been noted to cause <a href="/wiki/Hyperbilirubinemia" class="mw-redirect" title="Hyperbilirubinemia">hyperbilirubinemia</a> and nausea, so these side effects should be monitored for closely.</li></ul></li> <li><a href="/wiki/Integrase_inhibitor" title="Integrase inhibitor">Integrase inhibitors</a> (IIs) are generally the third drug in the regimen when a PI cannot be used. They rapidly reduce the viral load and for this reason, they are often used in women who are diagnosed with HIV late in their pregnancy. <a href="/wiki/Raltegravir" title="Raltegravir">Raltegravir</a> (RAL) is the most commonly used.<sup id="cite_ref-:17_44-1" class="reference"><a href="#cite_note-:17-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup></li> <li><a href="/wiki/Non-nucleoside_reverse_transcriptase_inhibitor" class="mw-redirect" title="Non-nucleoside reverse transcriptase inhibitor">Non-nucleoside reverse transcriptase inhibitors</a> (NNRTIs) may be used during pregnancy, however, there are significant toxicities associated with their use. NNRTIs are therefore them less desirable options for ART. The most commonly administered NNRTIs in pregnancy are <a href="/wiki/Efavirenz" title="Efavirenz">efavirenz</a> (EFV) and <a href="/wiki/Nevirapine" title="Nevirapine">nevirapine</a> (NVP).<sup id="cite_ref-:17_44-2" class="reference"><a href="#cite_note-:17-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup></li></ul> <div class="mw-heading mw-heading4"><h4 id="Pre-exposure_prophylaxis_(PrEP)"><span id="Pre-exposure_prophylaxis_.28PrEP.29"></span>Pre-exposure prophylaxis (PrEP)</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=15" title="Edit section: Pre-exposure prophylaxis (PrEP)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_(48610083847).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/98/Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_%2848610083847%29.jpg/220px-Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_%2848610083847%29.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/98/Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_%2848610083847%29.jpg/330px-Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_%2848610083847%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/98/Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_%2848610083847%29.jpg/440px-Gilead_Truvada_for_HIV_PrEP_-_Blue_Pills_%2848610083847%29.jpg 2x" data-file-width="7952" data-file-height="5304" /></a><figcaption></figcaption></figure> <p><a href="/wiki/Pre-exposure_prophylaxis" title="Pre-exposure prophylaxis">Pre-Exposure Prophylaxis</a> (PrEP) should be offered in the form of oral combination <a href="/wiki/Tenofovir_disoproxil" title="Tenofovir disoproxil">tenofovir disoproxil</a> fumarate/emtricitabine (TDF/FTC) to patients who are at risk of acquiring HIV and are trying to become pregnant, who are pregnant, who are postpartum/breastfeeding. People who are considered at risk for developing HIV are those who participate in condom-less sex with a partner who is HIV positive, patients who have been diagnosed with a recent sexually transmitted infection (STI), and patients who engage in injection drug use. PrEP is notably optional if a patient's HIV positive partner has been reliably on ART and has an undetectable viral load. PrEP can reduce the risk of both mother and fetal acquisition of HIV. Patients who take PrEP should be counseled on the importance of strict medication adherence and tested for HIV every three months and be aware of the symptoms of an acute HIV infection in case of viral contraction.<sup id="cite_ref-:21_12-1" class="reference"><a href="#cite_note-:21-12"><span class="cite-bracket">&#91;</span>12<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Nutritional_supplements">Nutritional supplements</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=16" title="Edit section: Nutritional supplements"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Vitamin_A" title="Vitamin A">Vitamin A</a> plays a role in the <a href="/wiki/Immune_system" title="Immune system">immune system</a> and has been suggested as a low-cost intervention that could help with preventing mother-to-child transmission of HIV. However, analysis of 5 large studies that utilized Vitamin A supplementation to prevent HIV transmission showed that said supplementation likely has little or no effect on transmission of the virus in pregnant women. Vitamin A supplementation has been largely superseded by antiretroviral therapy on a global basis.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">&#91;</span>45<span class="cite-bracket">&#93;</span></a></sup> Furthermore, high doses of natural Vitamin A can be toxic to the fetus, which is important to consider in management of HIV in pregnant women.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">&#91;</span>46<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Postnatal_care">Postnatal care</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=17" title="Edit section: Postnatal care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading4"><h4 id="Maternal_follow-up">Maternal follow-up</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=18" title="Edit section: Maternal follow-up"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The most important component of maternal follow-up for HIV positive mothers in the postnatal period is ART. All mothers should continue their antiretroviral medications following hospital discharge, and any changes to their regimens should be made in consultation with the physicians who coordinate their HIV care. The NIH also advises that providers should be wary of the unique challenges to medication compliance that mothers face in the postpartum period when designing a discharge ART regimen for their patients.<sup id="cite_ref-:20_47-0" class="reference"><a href="#cite_note-:20-47"><span class="cite-bracket">&#91;</span>47<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Infant_Treatment_and_Follow-Up">Infant Treatment and Follow-Up</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=19" title="Edit section: Infant Treatment and Follow-Up"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>All newborns who were exposed to HIV <i>in utero</i> should receive postpartum antiretroviral drugs within 6 hours of delivery, and their dosing should be based on the newborn's gestational age. <a href="/wiki/Preterm_birth" title="Preterm birth">Premature newborns</a> should only receive zidovudine, lamivudine, and/or nevirapine based on toxicity testing.<sup id="cite_ref-:18_48-0" class="reference"><a href="#cite_note-:18-48"><span class="cite-bracket">&#91;</span>48<span class="cite-bracket">&#93;</span></a></sup> </p><p>Newborns who were exposed to HIV <i>in utero</i> and whose mothers were on ART prior to and during pregnancy <i>and</i> achieved viral suppression by delivery should be administered zidovudine for 4 weeks to continue preventing HIV transmission following delivery. If a pregnant woman presents in labor with an unknown HIV status and a positive rapid HIV test result <i>or</i> an infant has a high risk of HIV transmission <i>in utero</i> (for example, the mother was not taking antiretroviral drugs in the pre-pregnancy period or during pregnancy, the mother had not achieved viral suppression, or the mother experienced an acute HIV infection during pregnancy or while breastfeeding), the infant should be started on a presumptive three drug ART regimen for treatment of the infection until the infant's test results are available. If the infant has a documented HIV infection after birth, they should be started on 3-drug ART at treatment doses that will be continued indefinitely.<sup id="cite_ref-:18_48-1" class="reference"><a href="#cite_note-:18-48"><span class="cite-bracket">&#91;</span>48<span class="cite-bracket">&#93;</span></a></sup> </p><p>In infants younger than 18 months, HIV testing must consist of virologic assays that directly detect the HIV virus, <i>not</i> HIV antibody testing, as it is less reliable in the postpartum period. The results of these tests can be affected by antiretroviral drugs, so they should be repeated. All infants exposed to HIV <i>in utero</i> should be tested at three ages: 14–21 days, 1–2 months, and 4–6 months. Any positive HIV testing should be repeated as soon as possible. HIV cannot be excluded as a diagnosis in an HIV-exposed, non-breastfed infant until the infant has had either two or more negative virologic tests at at least 1 month and 4 months of age, or two negative HIV antibody tests at at least 6 months of age.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">&#91;</span>49<span class="cite-bracket">&#93;</span></a></sup> </p><p>Other important testing for newborns includes a <a href="/wiki/Complete_blood_count" title="Complete blood count">complete blood count</a> at birth to determine a baseline for the infant's blood cell numbers. The infant should then be followed with appropriate laboratory monitoring based on their gestational age and clinical condition, and both the fetal and maternal drug regimens. Important hematologic anomalies being monitored include <a href="/wiki/Anemia" title="Anemia">anemia</a> and <a href="/wiki/Neutropenia" title="Neutropenia">neutropenia</a>. If either of these complications occur, the infant may need to discontinue their ART regimen under physician supervision. Infants exposed to HIV in utero should also be receive preventative drugs against <i><a href="/wiki/Pneumocystis_jirovecii" title="Pneumocystis jirovecii">Pneumocystis jirovecii</a></i> pneumonia between 4–6 weeks old after completing their 4-week course of antiretroviral medications, as this is a life-threatening complication of HIV.<sup id="cite_ref-:19_50-0" class="reference"><a href="#cite_note-:19-50"><span class="cite-bracket">&#91;</span>50<span class="cite-bracket">&#93;</span></a></sup> </p><p>Although the risk is very low, HIV can also be transmitted to a baby through food that was previously chewed by a mother or caretaker infected with HIV. To be safe, babies should not be fed pre-chewed food.<sup id="cite_ref-:19_50-1" class="reference"><a href="#cite_note-:19-50"><span class="cite-bracket">&#91;</span>50<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Breastfeeding">Breastfeeding</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=20" title="Edit section: Breastfeeding"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>While maternal compliance with ART reduces the chance of HIV transmission to the infant, there is still a risk of viral transmission via <a href="/wiki/Breast_milk" title="Breast milk">the breastmilk</a>. Furthermore, there is concern that maternal antiretroviral drugs can enter the breastmilk and cause toxicity issues in the infant or future drug resistance. For these reasons, the NIH, CDC, and the AAP each discourage <a href="/wiki/Breastfeeding" title="Breastfeeding">breastfeeding</a> amongst HIV-positive women in the United States and other developed nations because there are safe, affordable feeding alternatives and clean drinking water.<sup id="cite_ref-:20_47-1" class="reference"><a href="#cite_note-:20-47"><span class="cite-bracket">&#91;</span>47<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">&#91;</span>51<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">&#91;</span>52<span class="cite-bracket">&#93;</span></a></sup> In fact, ACOG lists maternal HIV infection as one of very few <a href="/wiki/Contraindication" title="Contraindication">contraindications</a> to breastfeeding.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">&#91;</span>53<span class="cite-bracket">&#93;</span></a></sup> </p><p>Despite these recommendations, some women in developed countries chose to breastfeed. In these situations, it is important that mothers adhere strictly to their ART regimens and it is advised that infants are administered antiretroviral drugs for the prevention of possible viral transmission for at least 6 weeks. Notably, when mothers do not comply with their ART regimens, there is a 15-20% risk of infant HIV acquisition from breastfeeding over 2 years. Both infants and mothers should be regularly tested every throughout breastfeeding to ensure appropriate viral suppression and lack of HIV transmission. Maternal monitoring should be done with an assessment of HIV viral load, and infant testing should be done with virologic HIV testing.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">&#91;</span>54<span class="cite-bracket">&#93;</span></a></sup> </p><p>The WHO dictates that in developing nations, the decision about whether or not mothers breastfeed their infants must weigh the risk of preventing HIV acquisition in the infant against the increased risk of death from malnutrition, diarrhea, and serious non-HIV infection if the infant is not breastfed.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> In developing nations, clean water and formula are not as readily available, therefore, breastfeeding is often encouraged to provide children with adequate food and nutrients because the benefit of nourishment outweighs the risk of HIV transmission.<sup id="cite_ref-who2013_56-0" class="reference"><a href="#cite_note-who2013-56"><span class="cite-bracket">&#91;</span>56<span class="cite-bracket">&#93;</span></a></sup> The WHO's 2010 HIV and Infant Feeding Recommendations intend to increase the rate of HIV-survival and reduce non-HIV related risk in infants and mothers, and they include the following:<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">&#91;</span>57<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li>National health authorities in each country should recommend one, specific, universal infant feeding practice for mothers with HIV, as mothers will need persistent counselling while feeding their infants and this is better promoted when national authorities are unified in the guidance they administer. The choices for feeding include either breastfeeding while receiving antiretroviral medications or avoidance of all breastfeeding.</li> <li>When national health authorities chose the feeding practice they intend to promote and determine how to implement it, they should consider HIV prevalence, infant and child mortality rates due to non-HIV causes, current infant and young child feeding, the nutritional status of children, water quality, sanitation resources, and quality of health services.</li> <li>women who breastfeed while receiving ART should exclusively breastfeed their infants for 6 months and then continue breastfeeding for until the infant is 12 months of age. They used to be advised to discontinue breastfeeding at 6 months, however, this recommendation has been changed to improve long-term nutritional outcomes.</li> <li>Mixed feeding (when a baby is fed formula and breastmilk) should be avoided to reduce the risk of HIV transmission and avoid diarrhea and malnutrition.</li></ul> <p>In developing nations, If the mother has a high HIV <a href="/wiki/Viral_load" title="Viral load">viral load</a> (HIV RNA more than 1000 copies/L), replacement feeding with formula is only initiated as per the <a href="/wiki/UNAIDS" class="mw-redirect" title="UNAIDS">UNAIDS</a> guidelines, termed the AFASS criteria, "where replacement feeding is acceptable, feasible, affordable, sustainable, and safe."<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">&#91;</span>58<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:10_33-1" class="reference"><a href="#cite_note-:10-33"><span class="cite-bracket">&#91;</span>33<span class="cite-bracket">&#93;</span></a></sup><sup>:95-6</sup> A mother should only give infant formula, as explained by the WHO, if the following conditions are met:<sup id="cite_ref-:9_59-0" class="reference"><a href="#cite_note-:9-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li>"Safe water and sanitation are assured at the household level and in the community; and</li> <li>the mother or other caregiver can reliably provide sufficient infant formula milk to support the normal growth and development of the infant; and</li> <li>the mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhea and malnutrition; and</li> <li>the mother or caregiver can exclusively give infant formula milk in the first six months; and</li> <li>the family is supportive of this practice; and</li> <li>the mother or caregiver can access health care that offers comprehensive child health services."</li></ul> <div class="mw-heading mw-heading2"><h2 id="Societal_impacts">Societal impacts</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=21" title="Edit section: Societal impacts"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Discrimination">Discrimination</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=22" title="Edit section: Discrimination"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Despite advances made in preventing transmission, HIV-positive women still face discrimination regarding their reproductive choices.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">&#91;</span>60<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">&#91;</span>61<span class="cite-bracket">&#93;</span></a></sup> In Asia, it was found that half the women living with HIV were advised not to have children and as many as 42% report being denied health services because of their HIV status.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">&#91;</span>62<span class="cite-bracket">&#93;</span></a></sup> </p><p><a href="/wiki/Compulsory_sterilization" title="Compulsory sterilization">Compulsory sterilisation</a> in an attempt to limit mother-to-child transmission has been practiced in Africa, Asia, and Latin American.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">&#91;</span>63<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">&#91;</span>64<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup> women are forced to undergo sterilisation without their knowledge or <a href="/wiki/Informed_consent" title="Informed consent">informed consent</a>, and misinformation and incentives are often used in order to coerce them into accepting the procedure. The forced sterilisation of HIV-positive women is internationally recognized as a violation of human rights.<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">&#91;</span>66<span class="cite-bracket">&#93;</span></a></sup> </p><p>Legal advocacy against this practice has occurred in some countries. In Namibia, litigation was brought against the government by three HIV-positive women who claimed they were coerced during labour into signing consent forms that gave permission for the hospital to perform a sterilisation.<sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">&#91;</span>67<span class="cite-bracket">&#93;</span></a></sup> The <i><a href="/wiki/LM_%26_Others_v_Government_of_Namibia" title="LM &amp; Others v Government of Namibia">LM &amp; Others v Government of Namibia</a></i> case is the first of its kind in sub-Saharan African to deal with coerced sterilisation of HIV-positive women. The court ruled that these women were sterilised without their consent but failed to find that this was due to their HIV status.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">&#91;</span>68<span class="cite-bracket">&#93;</span></a></sup> A 2010 case in Chile have also aimed to seek government accountability for violation of sexual and reproductive rights of women living with HIV.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">&#91;</span>69<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Health_considerations">Health considerations</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=23" title="Edit section: Health considerations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Pregnant women with HIV may still receive the trivalent inactivated <a href="/wiki/Influenza_vaccine" title="Influenza vaccine">influenza vaccine</a> and the tetanus, diphtheria, and pertussis (Tdap) vaccination during pregnancy.<sup id="cite_ref-MadhiCutland2014_70-0" class="reference"><a href="#cite_note-MadhiCutland2014-70"><span class="cite-bracket">&#91;</span>70<span class="cite-bracket">&#93;</span></a></sup> </p><p>Many patients who are HIV positive also have other health conditions known as <a href="/wiki/Comorbidity" title="Comorbidity">comorbidities</a>. Hepatitis B, hepatitis C, tuberculosis and injection drug use are some of the most common comorbidities associated with HIV. women who screen positive for HIV should also be tested for these conditions so that they may be adequately treated or controlled during the pregnancy. The comorbidities may have serious adverse effects on the mother and child during pregnancy, so it is extremely important to identify them early during the pregnancy.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">&#91;</span>71<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Health_disparities">Health disparities</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=24" title="Edit section: Health disparities"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are well documented disparities with regards to who is affected by HIV/AIDS during pregnancy.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">&#91;</span>72<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-:5_73-0" class="reference"><a href="#cite_note-:5-73"><span class="cite-bracket">&#91;</span>73<span class="cite-bracket">&#93;</span></a></sup> For example, a study of Florida births from 1998 to 2007 showed parents who were identified as Hispanic or Black in the medical records were more likely to have HIV during pregnancy.<sup id="cite_ref-:5_73-1" class="reference"><a href="#cite_note-:5-73"><span class="cite-bracket">&#91;</span>73<span class="cite-bracket">&#93;</span></a></sup> Though more research is needed, poverty is a significant structural inequity that can drive these differences in HIV rates.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">&#91;</span>74<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">&#91;</span>75<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">&#91;</span>76<span class="cite-bracket">&#93;</span></a></sup> Furthermore, there are large disparities in access to antiretroviral therapies, medications important in preventing the transmission of HIV from parent to child.<sup id="cite_ref-Zhang_2013_77-0" class="reference"><a href="#cite_note-Zhang_2013-77"><span class="cite-bracket">&#91;</span>77<span class="cite-bracket">&#93;</span></a></sup> Not receiving antiretroviral therapies was significantly associated with restricted Medicaid eligibility.<sup id="cite_ref-Zhang_2013_77-1" class="reference"><a href="#cite_note-Zhang_2013-77"><span class="cite-bracket">&#91;</span>77<span class="cite-bracket">&#93;</span></a></sup> This data suggests that improved insurance coverage to diagnose, screen, and treat pregnant individuals with HIV would help increase access to essential medications and reduce transmission of HIV from parent to child.<sup id="cite_ref-Zhang_2013_77-2" class="reference"><a href="#cite_note-Zhang_2013-77"><span class="cite-bracket">&#91;</span>77<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Support_groups">Support groups</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=25" title="Edit section: Support groups"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Bateganya et al. studied the impact of support groups for people living with HIV and found that 18/20 (90%) of papers reviewed showed support groups had a significant positive outcome.<sup id="cite_ref-:24_78-0" class="reference"><a href="#cite_note-:24-78"><span class="cite-bracket">&#91;</span>78<span class="cite-bracket">&#93;</span></a></sup> Studies show that support groups reduce morbidity (having disease or symptoms of disease), reduce mortality (likelihood of dying), increase quality of life, and increase use of healthcare.<sup id="cite_ref-:24_78-1" class="reference"><a href="#cite_note-:24-78"><span class="cite-bracket">&#91;</span>78<span class="cite-bracket">&#93;</span></a></sup> There is also research showing that support groups, in the short term, have a significant positive impact for pregnant women living with HIV.<sup id="cite_ref-:25_79-0" class="reference"><a href="#cite_note-:25-79"><span class="cite-bracket">&#91;</span>79<span class="cite-bracket">&#93;</span></a></sup> Mundell et al. showed that pregnant women enrolled in a support group had 1) improved self-esteem, 2) a greater ability to cope with their medical diagnoses, and 3) were more likely to follow up with healthcare services and share their HIV diagnosis with others than those not enrolled in a support group.<sup id="cite_ref-:25_79-1" class="reference"><a href="#cite_note-:25-79"><span class="cite-bracket">&#91;</span>79<span class="cite-bracket">&#93;</span></a></sup> This research suggests pregnant women living with HIV may benefit from peer support groups. </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=26" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-CDC_HIV_Surveillence-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-CDC_HIV_Surveillence_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CDC_HIV_Surveillence_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-CDC_HIV_Surveillence_1-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html">"HIV Surveillance Report"</a>. <i>U.S. Centers for Disease Control and Prevention</i>. May 2020.</cite><span title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=unknown&amp;rft.jtitle=U.S.+Centers+for+Disease+Control+and+Prevention.&amp;rft.atitle=HIV+Surveillance+Report&amp;rft.date=2020-05&amp;rft_id=http%3A%2F%2Fwww.cdc.gov%2Fhiv%2Flibrary%2Freports%2Fhiv-surveillance.html&amp;rfr_id=info%3Asid%2Fen.wikipedia.org%3AHIV+and+pregnancy" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation book cs1"><a rel="nofollow" class="external text" href="http://www.unaids.org/sites/default/files/media_asset/09_ChildrenandpregnantwomenlivingwithHIV.pdf"><i>Children and Pregnant Women Living with HIV</i></a> <span class="cs1-format">(PDF)</span>. UNAIDS. 2014. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a>&#160;<a href="/wiki/Special:BookSources/978-92-9253-062-4" title="Special:BookSources/978-92-9253-062-4"><bdi>978-92-9253-062-4</bdi></a>. <a href="/wiki/OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a>&#160;<a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/1248404125">1248404125</a>.</cite><span title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&amp;rft.genre=book&amp;rft.btitle=Children+and+Pregnant+Women+Living+with+HIV&amp;rft.pub=UNAIDS&amp;rft.date=2014&amp;rft_id=info%3Aoclcnum%2F1248404125&amp;rft.isbn=978-92-9253-062-4&amp;rft_id=http%3A%2F%2Fwww.unaids.org%2Fsites%2Fdefault%2Ffiles%2Fmedia_asset%2F09_ChildrenandpregnantwomenlivingwithHIV.pdf&amp;rfr_id=info%3Asid%2Fen.wikipedia.org%3AHIV+and+pregnancy" class="Z3988"></span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/mother-to-child-transmission-of-hiv">"Mother-to-child transmission of HIV"</a>. <i>www.who.int</i><span class="reference-accessdate">. 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text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017076">4017076</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a>&#160;<a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21973110">21973110</a>.</cite><span title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.jtitle=Women+%26+Health&amp;rft.atitle=The+impact+of+structured+support+groups+for+pregnant+South+African+women+recently+diagnosed+HIV+positive&amp;rft.volume=51&amp;rft.issue=6&amp;rft.pages=546-65&amp;rft.date=2011-08&amp;rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4017076%23id-name%3DPMC&amp;rft_id=info%3Apmid%2F21973110&amp;rft_id=info%3Adoi%2F10.1080%2F03630242.2011.606356&amp;rft.aulast=Mundell&amp;rft.aufirst=JP&amp;rft.au=Visser%2C+MJ&amp;rft.au=Makin%2C+JD&amp;rft.au=Kershaw%2C+TS&amp;rft.au=Forsyth%2C+BW&amp;rft.au=Jeffery%2C+B&amp;rft.au=Sikkema%2C+KJ&amp;rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4017076&amp;rfr_id=info%3Asid%2Fen.wikipedia.org%3AHIV+and+pregnancy" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=HIV_and_pregnancy&amp;action=edit&amp;section=27" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="http://www.aidsinfo.nih.gov/">aidsinfo.nih.gov</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20210322035857/https://aidsinfo.nih.gov/">Archived</a> 2021-03-22 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li></ul> <p><span class="noviewer" typeof="mw:File"><span><img alt="Public Domain" src="//upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/12px-PD-icon.svg.png" decoding="async" width="12" height="12" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/18px-PD-icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/6/62/PD-icon.svg/24px-PD-icon.svg.png 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.mw-parser-output .navbox{display:none!important}}</style></div><div role="navigation" class="navbox" aria-labelledby="HIV/AIDS_topics" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:HIV_and_AIDS" title="Template:HIV and AIDS"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:HIV_and_AIDS" title="Template talk:HIV and AIDS"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a 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href="/wiki/HIV_disease_progression_rates" title="HIV disease progression rates">disease progression rates</a></li> <li><a href="/wiki/National_Addiction_and_HIV_Data_Archive_Program" title="National Addiction and HIV Data Archive Program">National Addiction and HIV Data Archive Program</a></li></ul></li> <li><a href="/wiki/HIV/AIDS" title="HIV/AIDS">HIV/AIDS</a> <ul><li><a href="/wiki/Diagnosis_of_HIV/AIDS" title="Diagnosis of HIV/AIDS">diagnosis</a></li> <li><a href="/wiki/Management_of_HIV/AIDS" title="Management of HIV/AIDS">management</a></li> <li><a href="/wiki/Pathophysiology_of_HIV/AIDS" title="Pathophysiology of HIV/AIDS">pathophysiology</a></li> <li><a href="/wiki/Prevention_of_HIV/AIDS" title="Prevention of HIV/AIDS">prevention</a></li> <li><a href="/wiki/HIV/AIDS_research" title="HIV/AIDS research">research</a></li> <li><a href="/wiki/HIV_vaccine" class="mw-redirect" title="HIV vaccine">vaccination</a></li> <li><a href="/wiki/Pre-exposure_prophylaxis_for_HIV_prevention" title="Pre-exposure prophylaxis for HIV prevention">PrEP</a></li></ul></li> <li><a href="/wiki/WHO_disease_staging_system_for_HIV_infection_and_disease" title="WHO disease staging system for HIV infection and disease">WHO disease staging system for HIV infection and disease</a> <ul><li><a href="/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Children" title="WHO Disease Staging System for HIV Infection and Disease in Children">Children</a></li> <li><a href="/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents" title="WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents">Teens / Adults</a></li></ul></li> <li><a href="/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate" class="mw-redirect" title="List of countries by HIV/AIDS adult prevalence rate">Countries by AIDS prevalence rate</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Conditions</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Signs_and_symptoms_of_HIV/AIDS" title="Signs and symptoms of HIV/AIDS">Signs and symptoms</a></li> <li><a href="/wiki/AIDS-defining_clinical_condition" title="AIDS-defining clinical condition">AIDS-defining clinical condition</a></li> <li><a href="/wiki/Diffuse_infiltrative_lymphocytosis_syndrome" title="Diffuse infiltrative lymphocytosis syndrome">Diffuse infiltrative lymphocytosis syndrome</a></li> <li><a href="/wiki/HIV-associated_lipodystrophy" title="HIV-associated lipodystrophy">Lipodystrophy</a></li> <li><a href="/wiki/HIV-associated_nephropathy" title="HIV-associated nephropathy">Nephropathy</a></li> <li><a href="/wiki/HIV-associated_cardiomyopathy" title="HIV-associated cardiomyopathy">Cardiomyopathy</a></li> <li><a href="/wiki/HIV-associated_neurocognitive_disorder" title="HIV-associated neurocognitive disorder">Neurocognitive disorders</a></li> <li><a href="/wiki/HIV-associated_pruritus" title="HIV-associated pruritus">Pruritus</a></li> <li><a href="/wiki/Opportunistic_infection" title="Opportunistic infection">Opportunistic infection</a></li> <li><a href="/wiki/HIV_superinfection" title="HIV superinfection">Superinfection</a></li> <li><a href="/wiki/Tuberculosis" title="Tuberculosis">Tuberculosis co-infection</a></li> <li><a href="/wiki/HIV_Drug_Resistance_Database" title="HIV Drug Resistance Database">HIV Drug Resistance Database</a></li> <li><a href="/wiki/Innate_resistance_to_HIV" title="Innate resistance to HIV">Innate resistance to HIV</a></li> <li><a href="/wiki/Serostatus" title="Serostatus">Serostatus</a></li> <li><a href="/wiki/HIV-positive_people" title="HIV-positive people">HIV-positive people</a></li> <li><a href="/wiki/Nutritional_challenges_of_HIV/AIDS" title="Nutritional challenges of HIV/AIDS">Nutrition</a></li> <li><a class="mw-selflink selflink">Pregnancy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">History</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/History_of_HIV/AIDS" title="History of HIV/AIDS">History</a></li> <li><a href="/wiki/Epidemiology_of_HIV/AIDS" title="Epidemiology of HIV/AIDS">Epidemiology</a> <ul><li><a href="/wiki/Multiple_sex_partners" title="Multiple sex partners">Multiple sex partners</a></li></ul></li> <li><a href="/wiki/Timeline_of_HIV/AIDS" title="Timeline of HIV/AIDS">Timeline</a></li> <li><a href="/wiki/World_AIDS_Museum_and_Educational_Center" title="World AIDS Museum and Educational Center">World AIDS Museum</a></li> <li><a href="/wiki/Timothy_Ray_Brown" title="Timothy Ray Brown">Timothy Ray Brown</a></li> <li><a href="/wiki/Berlin_Patient" title="Berlin Patient">Berlin Patient</a></li> <li><a href="/wiki/Adam_Castillejo" title="Adam Castillejo">The London Patient</a></li> <li><a href="/wiki/Paul_Edmonds_(patient)" title="Paul Edmonds (patient)">City of Hope Patient</a></li> <li><a href="/wiki/Women_and_HIV/AIDS" title="Women and HIV/AIDS">Women and HIV/AIDS</a></li> <li><a href="/wiki/HIV_and_men_who_have_sex_with_men" title="HIV and men who have sex with men">HIV and homosexual men</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Social</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/AIDS_orphan" title="AIDS orphan">AIDS orphan</a></li> <li><a href="/wiki/Religion_and_HIV/AIDS" title="Religion and HIV/AIDS">Religion</a> <ul><li><a href="/wiki/Catholic_Church_and_HIV/AIDS" title="Catholic Church and HIV/AIDS">Catholic Church and HIV/AIDS</a></li></ul></li> <li><a href="/wiki/Circumcision_and_HIV" title="Circumcision and HIV">Circumcision and HIV</a></li> <li><a href="/wiki/Criminal_transmission_of_HIV" title="Criminal transmission of HIV">Criminal transmission</a></li> <li><a href="/wiki/Discrimination_against_people_with_HIV/AIDS" title="Discrimination against people with HIV/AIDS">Discrimination against people</a></li> <li><a href="/wiki/Economic_impact_of_HIV/AIDS" title="Economic impact of HIV/AIDS">Economic impact</a> <ul><li><a href="/wiki/Cost_of_HIV_treatment" title="Cost of HIV treatment">Cost of treatment</a></li></ul></li> <li><a href="/wiki/HIV-affected_community" title="HIV-affected community">HIV-affected community</a></li> <li><a href="/wiki/HIV/AIDS_activism" title="HIV/AIDS activism">HIV/AIDS activism</a></li> <li><a href="/wiki/HIV/AIDS_denialism" title="HIV/AIDS denialism">HIV/AIDS denialism</a></li> <li><a href="/wiki/Red_ribbon" title="Red ribbon">Red ribbon</a></li> <li><a href="/wiki/Safe_sex" title="Safe sex">Safe sex</a></li> <li><a href="/wiki/Sex_education" title="Sex education">Sex education</a></li> <li><a href="/wiki/List_of_HIV-positive_people" title="List of HIV-positive people">List of HIV-positive people</a></li> <li><a href="/wiki/People_With_AIDS" title="People With AIDS">People With AIDS Self-Empowerment Movement</a></li> <li><a href="/wiki/Sexually_transmitted_infections_in_the_pornography_industry" title="Sexually transmitted infections in the pornography industry">HIV/AIDS in the porn industry</a></li> <li><a href="/wiki/HIV.gov" title="HIV.gov">HIV.gov</a></li> <li><a href="/wiki/NAMES_Project_AIDS_Memorial_Quilt" title="NAMES Project AIDS Memorial Quilt">AIDS Memorial Quilt</a></li> <li><a href="/wiki/Product_Red" title="Product Red">Product Red</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Culture</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Discredited_HIV/AIDS_origins_theories" title="Discredited HIV/AIDS origins theories">Discredited HIV/AIDS origins theories</a></li> <li><a href="/wiki/European_and_Developing_Countries_Clinical_Trials_Partnership" title="European and Developing Countries Clinical Trials Partnership">European and Developing Countries Clinical Trials Partnership</a></li> <li><a href="/wiki/Elton_John_AIDS_Foundation" title="Elton John AIDS Foundation">Elton John AIDS Foundation</a></li> <li><a href="/wiki/International_AIDS_Conference" class="mw-redirect" title="International AIDS Conference">International AIDS Conference</a></li> <li><a href="/wiki/International_AIDS_Society" title="International AIDS Society">International AIDS Society</a></li> <li><a href="/wiki/Joint_United_Nations_Programme_on_HIV/AIDS" title="Joint United Nations Programme on HIV/AIDS">Joint United Nations Programme on HIV/AIDS (UNAIDS)</a></li> <li><a href="/wiki/Media_portrayal_of_HIV/AIDS" title="Media portrayal of HIV/AIDS">Media portrayal of HIV/AIDS</a></li> <li><a href="/wiki/Misconceptions_about_HIV/AIDS" title="Misconceptions about HIV/AIDS">Misconceptions about HIV/AIDS</a></li> <li><a href="/wiki/President%27s_Emergency_Plan_for_AIDS_Relief" title="President&#39;s Emergency Plan for AIDS Relief">President's Emergency Plan for AIDS Relief (PEPFAR)</a></li> <li><a href="/wiki/Sing_campaign" title="Sing campaign">The SING Campaign</a></li> <li><a href="/wiki/Solidays" title="Solidays">Solidays</a></li> <li><a href="/wiki/Treatment_Action_Campaign" title="Treatment Action Campaign">Treatment Action Campaign</a></li> <li><a href="/wiki/The_Global_Fund_to_Fight_AIDS,_Tuberculosis_and_Malaria" title="The Global Fund to Fight AIDS, Tuberculosis and Malaria">The Global Fund</a></li> <li><a href="/wiki/World_AIDS_Day" title="World AIDS Day">World AIDS Day</a></li> <li><a href="/wiki/Youth_Against_AIDS" title="Youth Against AIDS">YAA/Youthforce</a></li> <li><a href="/wiki/Free_Me_(Sia_song)" title="Free Me (Sia song)">"Free Me"</a></li> <li><a href="/wiki/Larry_Kramer" title="Larry Kramer">Larry Kramer</a> <ul><li><a href="/wiki/GMHC" title="GMHC">Gay Men's Health Crisis</a></li> <li><a href="/wiki/ACT_UP" title="ACT UP">ACT UP</a></li> <li><i><a href="/wiki/Reports_from_the_Holocaust" title="Reports from the Holocaust">Reports from the Holocaust</a></i></li> <li><a href="/wiki/AIDS%E2%80%93Holocaust_metaphor" title="AIDS–Holocaust metaphor">AIDS–Holocaust metaphor</a></li></ul></li> <li><a href="/wiki/Silence%3DDeath_Project" title="Silence=Death Project">Silence=Death Project</a></li> <li><a href="/wiki/Day_Without_Art" title="Day Without Art">Day Without Art</a></li> <li><a href="/wiki/The_Freddie_Mercury_Tribute_Concert" title="The Freddie Mercury Tribute Concert">The Freddie Mercury Tribute Concert</a></li> <li><a href="/wiki/Ayds" title="Ayds">Ayds</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epidemiology_of_HIV/AIDS" title="Epidemiology of HIV/AIDS">Locations</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/HIV/AIDS_in_Africa" title="HIV/AIDS in Africa">Africa</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_Angola" title="HIV/AIDS in Angola">Angola</a></li> <li><a href="/wiki/HIV/AIDS_in_Benin" title="HIV/AIDS in Benin">Benin</a></li> <li><a href="/wiki/HIV/AIDS_in_Botswana" title="HIV/AIDS in Botswana">Botswana</a></li> <li><a href="/wiki/HIV/AIDS_in_the_Democratic_Republic_of_the_Congo" title="HIV/AIDS in the Democratic Republic of the Congo">Democratic Republic of the Congo</a></li> <li><a href="/wiki/HIV/AIDS_in_Egypt" title="HIV/AIDS in Egypt">Egypt</a></li> <li><a href="/wiki/HIV/AIDS_in_Eswatini" title="HIV/AIDS in Eswatini">Eswatini</a></li> <li><a href="/wiki/HIV/AIDS_in_Ethiopia" title="HIV/AIDS in Ethiopia">Ethiopia</a></li> <li><a href="/wiki/HIV/AIDS_in_Ghana" title="HIV/AIDS in Ghana">Ghana</a></li> <li><a href="/wiki/HIV/AIDS_in_Guinea" title="HIV/AIDS in Guinea">Guinea</a></li> <li><a href="/wiki/HIV/AIDS_in_Ivory_Coast" title="HIV/AIDS in Ivory Coast">Côte d'Ivoire (Ivory Coast)</a></li> <li><a href="/wiki/HIV/AIDS_in_Kenya" title="HIV/AIDS in Kenya">Kenya</a></li> <li><a href="/wiki/HIV/AIDS_in_Lesotho" title="HIV/AIDS in Lesotho">Lesotho</a></li> <li><a href="/wiki/HIV/AIDS_in_Madagascar" title="HIV/AIDS in Madagascar">Madagascar</a></li> <li><a href="/wiki/HIV/AIDS_in_Malawi" title="HIV/AIDS in Malawi">Malawi</a></li> <li><a href="/wiki/HIV/AIDS_in_Mali" title="HIV/AIDS in Mali">Mali</a></li> <li><a href="/wiki/HIV/AIDS_in_Mozambique" title="HIV/AIDS in Mozambique">Mozambique</a></li> <li><a href="/wiki/HIV/AIDS_in_Namibia" title="HIV/AIDS in Namibia">Namibia</a></li> <li><a href="/wiki/HIV/AIDS_in_Niger" title="HIV/AIDS in Niger">Niger</a></li> <li><a href="/wiki/HIV/AIDS_in_Nigeria" title="HIV/AIDS in Nigeria">Nigeria</a></li> <li><a href="/wiki/HIV/AIDS_in_Rwanda" title="HIV/AIDS in Rwanda">Rwanda</a></li> <li><a href="/wiki/HIV/AIDS_in_Senegal" title="HIV/AIDS in Senegal">Senegal</a></li> <li><a href="/wiki/HIV/AIDS_in_Tanzania" title="HIV/AIDS in Tanzania">Tanzania</a></li> <li><a href="/wiki/HIV/AIDS_in_South_Africa" title="HIV/AIDS in South Africa">South Africa</a></li> <li><a href="/wiki/HIV/AIDS_in_Uganda" title="HIV/AIDS in Uganda">Uganda</a></li> <li><a href="/wiki/HIV/AIDS_in_Zambia" title="HIV/AIDS in Zambia">Zambia</a></li> <li><a href="/wiki/HIV/AIDS_in_Zimbabwe" title="HIV/AIDS in Zimbabwe">Zimbabwe</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/HIV/AIDS_in_Asia" title="HIV/AIDS in Asia">Asia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_Afghanistan" class="mw-redirect" title="HIV/AIDS in Afghanistan">Afghanistan</a></li> <li><a href="/wiki/HIV/AIDS_in_Armenia" title="HIV/AIDS in Armenia">Armenia</a></li> <li><a href="/wiki/HIV/AIDS_in_Azerbaijan" class="mw-redirect" title="HIV/AIDS in Azerbaijan">Azerbaijan</a></li> <li><a href="/wiki/HIV/AIDS_in_Bahrain" class="mw-redirect" title="HIV/AIDS in Bahrain">Bahrain</a></li> <li><a href="/wiki/HIV/AIDS_in_Bangladesh" title="HIV/AIDS in Bangladesh">Bangladesh</a></li> <li><a href="/wiki/HIV/AIDS_in_Bhutan" title="HIV/AIDS in Bhutan">Bhutan</a></li> <li><a href="/wiki/HIV/AIDS_in_Cambodia" title="HIV/AIDS in Cambodia">Cambodia</a></li> <li><a href="/wiki/HIV/AIDS_in_China" title="HIV/AIDS in China">China (PRC)</a> <ul><li><a href="/wiki/HIV/AIDS_in_Yunnan" title="HIV/AIDS in Yunnan">Yunnan</a></li></ul></li> <li><a href="/wiki/HIV/AIDS_in_East_Timor" title="HIV/AIDS in East Timor">East Timor</a></li> <li><a href="/wiki/HIV/AIDS_in_India" title="HIV/AIDS in India">India</a></li> <li><a href="/wiki/HIV/AIDS_in_Indonesia" title="HIV/AIDS in Indonesia">Indonesia</a></li> <li><a href="/wiki/HIV/AIDS_in_Iran" class="mw-redirect" title="HIV/AIDS in Iran">Iran</a></li> <li><a href="/wiki/HIV/AIDS_in_Iraq" title="HIV/AIDS in Iraq">Iraq</a></li> <li><a href="/wiki/HIV/AIDS_in_Japan" title="HIV/AIDS in Japan">Japan</a></li> <li><a href="/wiki/HIV/AIDS_in_Jordan" title="HIV/AIDS in Jordan">Jordan</a></li> <li><a href="/wiki/HIV/AIDS_in_North_Korea" class="mw-redirect" title="HIV/AIDS in North Korea">North Korea</a></li> <li><a href="/wiki/HIV/AIDS_in_Laos" title="HIV/AIDS in Laos">Laos</a></li> <li><a href="/wiki/HIV/AIDS_in_Malaysia" title="HIV/AIDS in Malaysia">Malaysia</a></li> <li><a href="/wiki/HIV/AIDS_in_Myanmar" title="HIV/AIDS in Myanmar">Myanmar (Burma)</a></li> <li><a href="/wiki/HIV/AIDS_in_Nepal" title="HIV/AIDS in Nepal">Nepal</a></li> <li><a href="/wiki/HIV/AIDS_in_Pakistan" title="HIV/AIDS in Pakistan">Pakistan</a></li> <li><a href="/wiki/HIV/AIDS_in_the_Philippines" title="HIV/AIDS in the Philippines">Philippines</a></li> <li><a href="/wiki/HIV/AIDS_in_Saudi_Arabia" class="mw-redirect" title="HIV/AIDS in Saudi Arabia">Saudi Arabia</a></li> <li><a href="/wiki/HIV/AIDS_in_Sri_Lanka" class="mw-redirect" title="HIV/AIDS in Sri Lanka">Sri Lanka</a></li> <li><a href="/wiki/HIV/AIDS_in_Taiwan" title="HIV/AIDS in Taiwan">Taiwan (ROC)</a></li> <li><a href="/wiki/HIV/AIDS_in_Thailand" title="HIV/AIDS in Thailand">Thailand</a></li> <li><a href="/wiki/HIV/AIDS_in_the_United_Arab_Emirates" title="HIV/AIDS in the United Arab Emirates">United Arab Emirates</a></li> <li><a href="/wiki/HIV/AIDS_in_Turkey" class="mw-redirect" title="HIV/AIDS in Turkey">Turkey</a></li> <li><a href="/wiki/HIV/AIDS_in_Vietnam" title="HIV/AIDS in Vietnam">Vietnam</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/HIV/AIDS_in_Europe" title="HIV/AIDS in Europe">Europe</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_the_United_Kingdom" title="HIV/AIDS in the United Kingdom">United Kingdom</a></li> <li><a href="/wiki/HIV/AIDS_in_Russia" title="HIV/AIDS in Russia">Russia</a></li> <li><a href="/wiki/HIV/AIDS_in_Ukraine" title="HIV/AIDS in Ukraine">Ukraine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/HIV/AIDS_in_North_America" title="HIV/AIDS in North America">North America</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_Canada" title="HIV/AIDS in Canada">Canada</a></li> <li><a href="/wiki/HIV/AIDS_in_Mexico" title="HIV/AIDS in Mexico">Mexico</a></li> <li><a href="/wiki/HIV/AIDS_in_El_Salvador" title="HIV/AIDS in El Salvador">El Salvador</a></li> <li><a href="/wiki/HIV/AIDS_in_Guatemala" title="HIV/AIDS in Guatemala">Guatemala</a></li> <li><a href="/wiki/HIV/AIDS_in_Honduras" title="HIV/AIDS in Honduras">Honduras</a></li> <li><a href="/wiki/HIV/AIDS_in_Nicaragua" title="HIV/AIDS in Nicaragua">Nicaragua</a></li> <li><a href="/wiki/HIV/AIDS_in_the_United_States" title="HIV/AIDS in the United States">United States</a> <ul><li><a href="/wiki/HIV/AIDS_in_New_York_City" title="HIV/AIDS in New York City">New York City</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/HIV/AIDS_in_the_Caribbean" title="HIV/AIDS in the Caribbean">Caribbean</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_Haiti" title="HIV/AIDS in Haiti">Haiti</a></li> <li><a href="/wiki/HIV/AIDS_in_Jamaica" title="HIV/AIDS in Jamaica">Jamaica</a></li> <li><a href="/wiki/HIV/AIDS_in_the_Dominican_Republic" title="HIV/AIDS in the Dominican Republic">Dominican Republic</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/HIV/AIDS_in_South_America" title="HIV/AIDS in South America">South America</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_Argentina" title="HIV/AIDS in Argentina">Argentina</a></li> <li><a href="/wiki/HIV/AIDS_in_Bolivia" title="HIV/AIDS in Bolivia">Bolivia</a></li> <li><a href="/wiki/HIV/AIDS_in_Brazil" title="HIV/AIDS in Brazil">Brazil</a></li> <li><a href="/wiki/HIV/AIDS_in_Colombia" title="HIV/AIDS in Colombia">Colombia</a></li> <li><a href="/wiki/HIV/AIDS_in_Guyana" title="HIV/AIDS in Guyana">Guyana</a></li> <li><a href="/wiki/HIV/AIDS_in_Peru" title="HIV/AIDS in Peru">Peru</a></li> <li><a href="/wiki/HIV/AIDS_in_Uruguay" title="HIV/AIDS in Uruguay">Uruguay</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Oceania</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HIV/AIDS_in_Australia" title="HIV/AIDS in Australia">Australia</a></li> <li><a href="/wiki/HIV/AIDS_in_New_Zealand" title="HIV/AIDS in New Zealand">New Zealand</a></li> <li><a href="/wiki/HIV/AIDS_in_Papua_New_Guinea" title="HIV/AIDS in Papua New Guinea">Papua New Guinea</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><a href="/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate" class="mw-redirect" title="List of countries by HIV/AIDS adult prevalence rate">List of countries by HIV/AIDS adult prevalence rate</a></li> <li><a href="/wiki/List_of_HIV/AIDS_cases_and_deaths_registered_by_region" title="List of HIV/AIDS cases and deaths registered by region">List of HIV/AIDS cases and deaths registered by region</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pregnancy_and_childbirth" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pregnancy" title="Template:Pregnancy"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Pregnancy" title="Template talk:Pregnancy"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pregnancy" title="Special:EditPage/Template:Pregnancy"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pregnancy_and_childbirth" style="font-size:114%;margin:0 4em"><a href="/wiki/Pregnancy" title="Pregnancy">Pregnancy</a> and <a href="/wiki/Childbirth" title="Childbirth">childbirth</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Family_planning" title="Family planning">Planning</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Birth_control" title="Birth control">Birth control</a></li> <li><a href="/wiki/Natural_family_planning" title="Natural family planning">Natural family planning</a></li> <li><a href="/wiki/Male_contraceptive" title="Male contraceptive">Male contraceptive</a></li> <li><a href="/wiki/Pre-conception_counseling" title="Pre-conception counseling">Pre-conception counseling</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_fertilization" title="Human fertilization">Conception</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Assisted_reproductive_technology" title="Assisted reproductive technology">Assisted reproductive technology</a> <ul><li><a href="/wiki/Artificial_insemination" title="Artificial insemination">artificial insemination</a></li> <li><a href="/wiki/Fertility_fraud" title="Fertility fraud">fertility fraud</a></li> <li><a href="/wiki/Fertility_medication" title="Fertility medication">fertility medication</a></li> <li><a href="/wiki/In_vitro_fertilisation" title="In vitro fertilisation">in vitro fertilisation</a></li> <li><a href="/wiki/Partner-assisted_reproduction" title="Partner-assisted reproduction">partner-assisted reproduction</a></li></ul></li> <li><a href="/wiki/Fertility_awareness" title="Fertility awareness">Fertility awareness</a></li> <li><a href="/wiki/Unintended_pregnancy" title="Unintended pregnancy">Unintended pregnancy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Testing</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/3D_ultrasound" title="3D ultrasound">3D ultrasound</a></li> <li><a href="/wiki/Obstetric_ultrasonography" title="Obstetric ultrasonography">Obstetric ultrasonography</a></li> <li><a href="/wiki/Pregnancy_test" title="Pregnancy test">Pregnancy test</a> <ul><li><a href="/wiki/HCG_pregnancy_strip_test" class="mw-redirect" title="HCG pregnancy strip test">home testing</a></li></ul></li> <li><a href="/wiki/Prenatal_testing" title="Prenatal testing">Prenatal testing</a></li> <li><a href="/wiki/Medical_imaging_in_pregnancy" title="Medical imaging in pregnancy">Medical imaging</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Types</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cervical_pregnancy" title="Cervical pregnancy">Cervical</a></li> <li><a href="/wiki/Cryptic_pregnancy" title="Cryptic pregnancy">Cryptic</a></li> <li><a href="/wiki/Ectopic_pregnancy" title="Ectopic pregnancy">Ectopic</a></li> <li><a href="/wiki/Abdominal_pregnancy" title="Abdominal pregnancy">Abdominal</a></li> <li><a href="/wiki/Heterotopic_pregnancy" title="Heterotopic pregnancy">Heterotopic</a></li> <li><a href="/wiki/Molar_pregnancy" title="Molar pregnancy">Molar</a></li> <li><a href="/wiki/Ovarian_pregnancy" title="Ovarian pregnancy">Ovarian</a></li> <li><a href="/wiki/Postterm_pregnancy" title="Postterm pregnancy">Postterm</a></li> <li><a href="/wiki/Unintended_pregnancy" title="Unintended pregnancy">Unintended</a></li> <li><a href="/wiki/Interstitial_pregnancy" title="Interstitial pregnancy">Interstitial</a></li> <li><a href="/wiki/Rudimentary_horn_pregnancy" title="Rudimentary horn pregnancy">Rudimentary horn</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Childbirth" title="Childbirth">Childbirth</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Preparation</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bradley_method_of_natural_childbirth" title="Bradley method of natural childbirth">Bradley method</a></li> <li><a href="/wiki/Hypnotherapy_in_childbirth" class="mw-redirect" title="Hypnotherapy in childbirth">Hypnobirthing</a></li> <li><a href="/wiki/Lamaze_technique" title="Lamaze technique">Lamaze</a></li> <li><a href="/wiki/Nesting_instinct" title="Nesting instinct">Nesting instinct</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Roles</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Mother" title="Mother">Mother</a></li> <li><a href="/wiki/Infant" title="Infant">Newborn</a> <ul><li><a href="/wiki/Preterm_birth" title="Preterm birth">Preterm birth</a></li></ul></li> <li><a href="/wiki/Postterm_pregnancy" title="Postterm pregnancy">Postterm pregnancy</a></li> <li><a href="/wiki/Doula" title="Doula">Doula</a></li> <li><a href="/wiki/Birth_attendant" title="Birth attendant">Birth attendant</a></li> <li><a href="/wiki/Men%27s_role_in_childbirth" title="Men&#39;s role in childbirth">Men's roles</a></li> <li><a href="/wiki/Midwife" title="Midwife">Midwife</a> <ul><li><a href="/wiki/Auxiliary_nurse_midwife" title="Auxiliary nurse midwife">Auxiliary nurse midwife</a></li></ul></li> <li><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrician</a></li> <li><a href="/wiki/Obstetrical_nursing" title="Obstetrical nursing">Perinatal nurse</a></li> <li><a href="/wiki/Traditional_birth_attendant" title="Traditional birth attendant">Traditional birth attendant</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Delivery</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pelvimetry" title="Pelvimetry">Pelvimetry</a> / <a href="/wiki/Bishop_score" title="Bishop score">Bishop score</a> <ul><li><a href="/wiki/Cervical_dilation" title="Cervical dilation">cervical dilation</a></li> <li><a href="/wiki/Cervical_effacement" title="Cervical effacement">cervical effacement</a></li> <li><a href="/wiki/Position_(obstetrics)" title="Position (obstetrics)">position</a></li></ul></li> <li><a href="/wiki/Bloody_show" title="Bloody show">Bloody show</a></li> <li><a href="/wiki/Uterine_contraction" title="Uterine contraction">Uterine contraction</a></li> <li><a href="/wiki/Vaginal_delivery" title="Vaginal delivery">Vaginal delivery</a></li> <li><a href="/wiki/Presentation_(obstetrics)" title="Presentation (obstetrics)">Presentation</a> <ul><li><a href="/wiki/Breech_birth" title="Breech birth">breech</a></li> <li><a href="/wiki/Cephalic_presentation" title="Cephalic presentation">cephalic</a></li> <li><a href="/wiki/Shoulder_presentation" title="Shoulder presentation">shoulder</a></li></ul></li> <li><a href="/wiki/Rupture_of_membranes" title="Rupture of membranes">Rupture of membranes</a></li> <li><a href="/wiki/Caesarean_section" title="Caesarean section">Caesarean</a></li> <li><a href="/wiki/Childbirth_positions" title="Childbirth positions">Childbirth positions</a></li> <li><a href="/wiki/Home_birth" title="Home birth">Home birth</a></li> <li><a href="/wiki/Labor_induction" title="Labor induction">Labor induction</a></li> <li><a href="/wiki/Multiple_birth" title="Multiple birth">Multiple birth</a></li> <li><a href="/wiki/Natural_childbirth" title="Natural childbirth">Natural childbirth</a></li> <li><a href="/wiki/Silent_birth" title="Silent birth">Silent birth</a></li> <li><a href="/wiki/Unassisted_childbirth" title="Unassisted childbirth">Unassisted childbirth</a></li> <li><a href="/wiki/Water_birth" title="Water birth">Water birth</a></li> <li><a href="/wiki/Placental_expulsion" title="Placental expulsion">Placental expulsion</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Prenatal</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Anatomy</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amniotic_fluid" title="Amniotic fluid">Amniotic fluid</a></li> <li><a href="/wiki/Amniotic_sac" title="Amniotic sac">Amniotic sac</a></li> <li><a href="/wiki/Endometrium" title="Endometrium">Endometrium</a></li> <li><a href="/wiki/Placenta" title="Placenta">Placenta</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Prenatal_development" title="Prenatal development">Development</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Human_embryonic_development" title="Human embryonic development">Embryo</a></li> <li><a href="/wiki/Fetus" title="Fetus">Fetus</a></li> <li><a href="/wiki/Fundal_height" title="Fundal height">Fundal height</a></li> <li><a href="/wiki/Gestational_age" title="Gestational age">Gestational age</a></li> <li><a href="/wiki/Maternal_physiological_changes_in_pregnancy" title="Maternal physiological changes in pregnancy">Maternal physiological changes</a></li> <li><a href="/wiki/Postpartum_physiological_changes" title="Postpartum physiological changes">Postpartum physiological changes</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Prenatal_care" title="Prenatal care">Care</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Brain_health_and_pollution" title="Brain health and pollution">Brain health and pollution</a></li> <li>Nutrition <ul><li><a href="/wiki/Environmental_toxicants_and_fetal_development" title="Environmental toxicants and fetal development">environmental toxicants</a></li> <li><a href="/wiki/Nutrition_and_pregnancy" title="Nutrition and pregnancy">in pregnancy</a></li> <li><a href="/wiki/Prenatal_nutrition" title="Prenatal nutrition">prenatal</a></li></ul></li> <li><a href="/wiki/Antenatal_depression" title="Antenatal depression">Prenatal depression</a></li> <li><a href="/wiki/Immunization_during_pregnancy" title="Immunization during pregnancy">Immunization</a></li> <li>Concomitant conditions <ul><li><a href="/wiki/Anemia_in_pregnancy" title="Anemia in pregnancy">Anemia</a></li> <li><a href="/wiki/Hypertensive_disease_of_pregnancy" title="Hypertensive disease of pregnancy">Hypertension</a></li> <li><a href="/wiki/Hypercoagulability_in_pregnancy" title="Hypercoagulability in pregnancy">Hypercoagulability</a></li> <li><a href="/wiki/Drugs_in_pregnancy" title="Drugs in pregnancy">Substance use</a> <ul><li><a href="/wiki/Smoking_and_pregnancy" title="Smoking and pregnancy">Smoking</a></li> <li><a href="/wiki/Alcohol_and_pregnancy" class="mw-redirect" title="Alcohol and pregnancy">Alcohol</a></li> <li><a href="/wiki/Cannabis_in_pregnancy" title="Cannabis in pregnancy">Cannabis</a></li> <li><a href="/wiki/Opioids_and_pregnancy" title="Opioids and pregnancy">Opioids</a></li></ul></li> <li>Endocrine diseases <ul><li><a href="/wiki/Diabetes_and_pregnancy" title="Diabetes and pregnancy">Diabetes</a></li> <li><a href="/wiki/Thyroid_disease_in_pregnancy" title="Thyroid disease in pregnancy">Thyroid disease</a></li></ul></li> <li>Liver diseases <ul><li><a href="/wiki/Acute_fatty_liver_of_pregnancy" title="Acute fatty liver of pregnancy">Acute fatty liver</a></li> <li><a href="/wiki/Intrahepatic_cholestasis_of_pregnancy" title="Intrahepatic cholestasis of pregnancy">Intrahepatic cholestasis</a></li></ul></li> <li>Infections <ul><li><a class="mw-selflink selflink">HIV</a></li> <li><a href="/wiki/COVID-19_in_pregnancy" title="COVID-19 in pregnancy">COVID-19</a></li> <li><a href="/wiki/HCV_in_children_and_pregnancy" title="HCV in children and pregnancy">Hepatitis C</a></li> <li><a href="/wiki/Pregnancy-associated_malaria" title="Pregnancy-associated malaria">Malaria</a></li></ul></li> <li>Skin diseases <ul><li><a href="/wiki/Lupus_and_pregnancy" title="Lupus and pregnancy">Lupus</a></li> <li><a href="/wiki/Pruritic_folliculitis_of_pregnancy" title="Pruritic folliculitis of pregnancy">Pruritic folliculitis</a></li> <li><a href="/wiki/Dermatoses_of_pregnancy" title="Dermatoses of pregnancy">Dermatoses</a></li></ul></li> <li>Others <ul><li><a href="/wiki/Drugs_in_pregnancy" title="Drugs in pregnancy">Drugs</a></li> <li><a href="/wiki/Vaginal_flora_in_pregnancy" title="Vaginal flora in pregnancy">Vaginal flora</a></li> <li><a href="/wiki/Obstetrical_bleeding" title="Obstetrical bleeding">Bleeding</a></li> <li><a href="/wiki/Motor_vehicle_emissions_and_pregnancy" class="mw-redirect" title="Motor vehicle emissions and pregnancy">Motor vehicle emissions</a></li> <li><a href="/wiki/Pre-existing_disease_in_pregnancy" title="Pre-existing disease in pregnancy">Pre-existing disease</a></li> <li><a href="/wiki/Pregnancy_and_sleep" title="Pregnancy and sleep">Sleep</a></li></ul></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Procedures</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amniocentesis" title="Amniocentesis">Amniocentesis</a></li> <li><a href="/wiki/Cardiotocography" title="Cardiotocography">Cardiotocography</a></li> <li><a href="/wiki/Chorionic_villus_sampling" title="Chorionic villus sampling">Chorionic villus sampling</a></li> <li><a href="/wiki/Nonstress_test" title="Nonstress test">Nonstress test</a></li> <li><a href="/wiki/Abortion" title="Abortion">Abortion</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Postpartum_period" title="Postpartum period">Postpartum</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Maternal</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Lochia" title="Lochia">Lochia</a></li> <li><a href="/wiki/Postpartum_care" title="Postpartum care">Postpartum care</a></li> <li><a href="/wiki/Postpartum_depression" title="Postpartum depression">Postpartum depression</a></li> <li><a href="/wiki/Postpartum_confinement" title="Postpartum confinement">Postpartum confinement</a></li> <li><a href="/wiki/Sex_after_pregnancy" title="Sex after pregnancy">Sex after pregnancy</a></li> <li><a href="/wiki/Psychiatric_disorders_of_childbirth" title="Psychiatric disorders of childbirth">Psychiatric disorders of childbirth</a></li> <li><a href="/wiki/Postpartum_physiological_changes" title="Postpartum physiological changes">Postpartum physiological changes</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Roles</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Doula" title="Doula">Doula</a></li> <li><a href="/wiki/Health_visitor" title="Health visitor">Health visitor</a></li> <li><a href="/wiki/Lactation_consultant" title="Lactation consultant">Lactation consultant</a></li> <li><a href="/wiki/Monthly_nurse" title="Monthly nurse">Monthly nurse</a></li> <li><a href="/wiki/Nanny#Maternity_nurse_/_newborn_care_specialists_/_confinement_nanny" title="Nanny">Confinement nanny</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Infant</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adaptation_to_extrauterine_life" title="Adaptation to extrauterine life">Adaptation to extrauterine life</a></li> <li><a href="/wiki/Apgar_score" title="Apgar score">Apgar score</a></li> <li><a href="/wiki/Child_care" title="Child care">Child care</a></li> <li><a href="/wiki/Birth_defect" title="Birth defect">Congenital disorders</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Obstetric history</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gravidity_and_parity" title="Gravidity and parity">Gravidity and parity</a></li></ul> </div></td></tr></tbody></table></div> <!-- NewPP limit report Parsed by mw‐web.codfw.main‐f69cdc8f6‐486j8 Cached time: 20241122153130 Cache expiry: 2592000 Reduced expiry: false Complications: [vary‐revision‐sha1, show‐toc] CPU time usage: 0.961 seconds Real time usage: 1.068 seconds Preprocessor visited node count: 4701/1000000 Post‐expand include size: 264120/2097152 bytes Template argument size: 468/2097152 bytes Highest expansion depth: 14/100 Expensive parser function count: 3/500 Unstrip recursion depth: 1/20 Unstrip post‐expand size: 331629/5000000 bytes Lua time usage: 0.571/10.000 seconds Lua memory usage: 5268292/52428800 bytes Number of Wikibase entities loaded: 0/400 --> <!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 873.022 1 -total 62.26% 543.521 1 Template:Reflist 28.72% 250.705 41 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