Effects of HIV, Viral Hepatitis and STIs on Pregnancy and Infants

At a glance

Infection with HIV, viral hepatitis, or STIs can affect the wellbeing of the mother, the pregnancy outcome, and child. HIV, hepatitis B, hepatitis C, and syphilis infection can have particularly serious health consequences for both mothers and infants. Not all pregnant women and their infants/children are equally affected by HIV, hepatitis B, hepatitis C, and congenital syphilis.

A mother cradles an infant child.

Overview

In 2021 in the United States, 62% of the diagnoses of HIV infection among children aged less than 13 years were among Blacks/African American people, 21% were among Hispanic/Latino people, and 9% were among White people.1

Infants with perinatal hepatitis B are more likely to have a younger mother and be of Asian/Pacific Islander race. 2

Rates of hepatitis C diagnosed at delivery in hospitals are substantially higher among women with opioid use disorder, as a result of the opioid crisis and related increases in HCV infection.3

The highest diagnosis rates of congenital syphilis during 2022 were among American Indian/Alaska Native people followed by non-Hispanic Black people and occurred among people in the U.S. southern and western regions.4

HIV

Infants born with HIV who remain undiagnosed are vulnerable to disease progression during the first 1–2 years of life, including opportunistic infections and encephalopathy. Because of advances in HIV care and treatment, an AIDS diagnosis (Stage 3 HIV diagnosis) among children born with HIV is highly uncommon, particularly among infants born after the use of antiretroviral therapy became routine.

3,915‎

Estimated live births among pregnant people with diagnosed HIV, 20145

Number of women aged 13-44 years living with diagnosed HIV infection, United States6

Number of HIV diagnoses among infants, United States789

HBV

Hepatitis B virus infection in a pregnant woman poses a serious risk to her infant at birth. Without postexposure prophylaxis, as many as 90% of infants born to HBV-infected mothers in the United States will become infected with HBV. Subsequently, 90% of those infants develop chronic HBV infection and approximately one-fourth of these infants eventually will die from liver-related complications. A vaccine for hepatitis B is available, and, during the last 30 years, vaccination has prevented more than half a million U.S. children from acquiring the disease. Although the hepatitis B vaccine successfully prevents infection, women who have had the vaccine for hepatitis B should still get screened during every pregnancy.

120,000‎

Estimated number of women aged 15-44 years with HBV infectionA

952‎

Estimated number of infants with chronic HBV infection during 200910

20,832 estimated and 10,956 identified‎

Number of infants at risk for hepatitis B during 2017 because they were born to pregnant women with HBV infection11

HCV

About 6 in 100 infants born to mothers with hepatitis C become infected with the hepatitis C virus, and the risk of transmission is higher if the mother is also HIV positive.12 While there is no treatment available to prevent transmission of HCV from mother to child during pregnancy, screening for HCV infection during pregnancy allows health care providers to simultaneously identify infected mothers who should receive treatment during the postpartum period and infants who should receive testing during a pediatric visit. 13Curative treatment is not approved for children under age 3 years, infants who test HCV RNA positive at age 2 months or older, or HCV antibody positive at age 18 months or older. These infants should be monitored by a specialist who can initiate treatment with direct-acting antivirals at age ≥ 3 years.14

29,000‎

Estimated number of women with HCV infection who gave birth each year during 2006 - 201415

1,700‎

Estimated number of infants born with HCV infection each year during 2011 - 201415

Rate of maternal HCV infection at delivery, United States16

Syphilis

5,726‎

Number of pregnant people diagnosed with syphilis (any stage), United States17

Congenital syphilis can have a major health impact on a baby, but how it affects the baby's health depends on when syphilis was acquired in pregnancy and if — or when — the mother received treatment for the infection. Syphilis in pregnant women can cause miscarriage, stillbirth, or the baby's death shortly after birth. Approximately 40% of babies born to women with untreated syphilis can be stillborn or die from the infection as a newborn. Babies born with congenital syphilis can have bone damage, severe anemia, enlarged liver and spleen, jaundice, nerve problems causing blindness or deafness, meningitis, or skin rashes.

Syphilis can be treated effectively with a penicillin regimen that is both appropriate for the stage of syphilis and initiated 30 days or more before delivery. Pregnant women diagnosed with syphilis should be treated immediately. Their sex partner(s) should also receive treatment to prevent the mother from becoming re-infected and to improve the health of her partner. Infants exposed to syphilis during pregnancy should be thoroughly evaluated at birth to assess for evidence of congenital syphilis and need for treatment. These infants should also be closely followed post-delivery, regardless of initial evaluation or treatment, because infants with CS may not have any initial symptoms at birth but later develop symptoms of CS if not treated appropriately. Infants with CS who are not treated appropriately within the first 3 months of life are more likely to have lifelong complications of CS such as deafness, blindness, and intellectual disability.1819

Number of congenital syphilis cases, United States20

Number of primary and secondary syphilis cases among women aged 15 to 44 years, United States 20

Print
Content Source:
National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention
  1. Estimate represents U.S. civilian, non-institutionalized, household population of women aged 15-44 years and is based on 2013-2018 National Health and Nutrition Examination Survey data and the average annual population during that time. The estimate meets all criteria established by the National Center for Health Statistics for publication except that the confidence interval width is about 6% larger than the recommended threshold. The number of women with HBV infection at the end of 2015 could be as low as 70,000 or as high as 203,000.
  1. Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas, 2021. https://www.cdc.gov/hiv-data/nhss/hiv-diagnoses-deaths-prevalence.html
  2. Schillie S, Talker T, Veselsky S, et al. Outcomes of infants born to women infected with hepatitis B. Pediatrics 2015;135(5):e1141-1147.
  3. Ko JY, Haight SC, Schillie SF, Bohm MK, Dietz PM. National Trends in Hepatitis C Infection by Opioid Use Disorder Status Among Pregnant Women at Delivery Hospitalization — United States, 2000–2015. MMWR Morb Mortal Wkly Rep 2019;68:833–838.
  4. Centers for Disease Control and Prevention. CDC’s 2022 STI Surveillance Report underscores that STIs must be a public health priority
  5. Aslam et al, Trends in Women with an HIV Diagnosis at Delivery Hospitalization in the United States, 2006-2014. 2020. Pub Health Reports; 135(4); https://doi.org/10.1177/0033354920935074.
  6. Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. Accessed June 28, 2022.
  7. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2017. HIV Surveillance Supplemental Report 2019;24(No. 3). Table 8b, years 2010-2013.
  8. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. HIV Surveillance Supplemental Report 2020;25(No. 2). Table 9b, years 2014-2015.
  9. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020. HIV Surveillance Supplemental Report 2022;27(No. 3). Table 9b, years 2016-2019.
  10. Ko SC, Fan L, Smith, EA, et al. Estimated annual perinatal hepatitis B virus infections in the United States, 2000-2009external icon. J of Ped Infect Dis Soc 2016;5:114–21.
  11. Koneru A, Fenlon N, Schillie S, et al. National Perinatal Hepatitis B Prevention Program: 2009–2017. Pediatrics. 2021;147(3):e20201823
  12. Centers for Disease Control and Prevention. Hepatitis C Questions and Answers for the Public. Available at: https://www.cdc.gov/hepatitis-c/about/index.html. Accessed May 18, 2020
  13. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020;69(No. RR-2):1–17. DOI: http://dx.doi.org/10.15585/mmwr.rr6902a1.
  14. AASLD-IDSA. HCV testing and linkage to care. Recommendations for testing, managing, and treating hepatitis C. Available at: http://www.hcvguidelines.org/unique-populations/children. Accessed July 1, 2022.
  15. Ly, K. N., Jiles, R. B., Teshale, E. H., Foster, M. A., Pesano, R. L., & Holmberg, S. D. (2017). Hepatitis C virus infection among reproductive-aged women and children in the United States, 2006 to 2014. Annals of internal medicine, 166(11), 775-782.
  16. Ko JY, Haight SC, Schillie SF, Bohm MK, Dietz PM. National Trends in Hepatitis C Infection by Opioid Use Disorder Status Among Pregnant Women at Delivery Hospitalization — United States, 2000–2015. MMWR Morb Mortal Wkly Rep 2019;68:833–838. DOI: http://dx.doi.org/10.15585/mmwr.mm6839a1.
  17. Centers for Disease Control and Prevention. 2020 Sexually transmitted diseases surveillance. 2020 STD Surveillance Congenital Syphilis Figures. Accessed June 28, 2022.
  18. Lago EG, Vaccari A, Fiori RM. Clinical features and follow-up of congenital syphilis. Sex Transm Dis. 2013;40(2):85–94
  19. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports. 2021 Jul 23;70(4):1.
  20. Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. Accessed June 2020.
  • Koneru A, Fenlon N, Schillie S, et al. National Perinatal Hepatitis B Prevention Program: 2009–2017. Pediatrics. 2021;147(3):e20201823