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Pregnancy and perinatal transmission

Pregnancy and perinatal transmission is a topic covered in the Johns Hopkins HIV Guide.

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  • Approximate risk of mother to child transmission (MTCT) of HIV is 15-30% for live births (mostly intrapartum) and 15% during breastfeeding. Taken together risk of HIV transmission during pregnancy, delivery, and breastfeeding is approximately 20-40% without prevention measures (without PMTCT).
  • Risks include higher maternal VL, lower CD4 count, severe prematurity (< 33 wks), multiple gestation (twin A at higher risk), smoking, active HSV, genital ulcer disease. Risk lower with low VL, effective ART, Cesarean section delivery (when VL not suppressed), intrapartum ART, formula feeding.
  • Antenatal and post-natal PMTCT can decrease transmission to < 1%.
  • Pregnancy does not increase HIV progression, risk of OIs, or HIV-related survival. Hemodilution of pregnancy may cause apparent decrease in absolute CD4 (not CD4%).

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Last updated: July 31, 2016


Hoffmann, Christopher J. "Pregnancy and Perinatal Transmission." Johns Hopkins HIV Guide, 2016. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545169/all/Pregnancy_and_perinatal_transmission.
Hoffmann CJ. Pregnancy and perinatal transmission. Johns Hopkins HIV Guide. 2016. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545169/all/Pregnancy_and_perinatal_transmission. Accessed August 19, 2019.
Hoffmann, C. J. (2016). Pregnancy and perinatal transmission. In Johns Hopkins HIV Guide. Available from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545169/all/Pregnancy_and_perinatal_transmission
Hoffmann CJ. Pregnancy and Perinatal Transmission [Internet]. In: Johns Hopkins HIV Guide. ; 2016. [cited 2019 August 19]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545169/all/Pregnancy_and_perinatal_transmission.
* Article titles in AMA citation format should be in sentence-case
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