Pregnancy and perinatal transmission
DEFINITION
- Without the use of preventive measures, the 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%.
- Use of antenatal and post-natal prevention of mother to child transmission (PMTCT) reduces risk to < 1%.
- Risks of transmission include higher maternal VL, lower CD4 count, severe prematurity (< 33 wks), multiple gestation (twin A at higher risk), smoking, active HSV, genital ulcer disease.
- 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 12, 2025
Citation
Hoffmann, Christopher J. "Pregnancy and Perinatal Transmission." Johns Hopkins HIV Guide, The Johns Hopkins University, 2025. Johns Hopkins Guides, 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. The Johns Hopkins University; 2025. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545169/all/Pregnancy_and_perinatal_transmission. Accessed October 3, 2025.
Hoffmann, C. J. (2025). Pregnancy and perinatal transmission. In Johns Hopkins HIV Guide. The Johns Hopkins University. 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. The Johns Hopkins University; 2025. [cited 2025 October 03]. 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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