How is HIV transmitted from mother to child?

• A. In utero, during delivery, or through breastfeeding; reduces with maternal ART and delivery strategies.
• B. Only during delivery.
• C. Only through breastfeeding.
• D. Transmission cannot be reduced with ART.

Answer: (A)

HIV can be passed from mother to child at three times: during pregnancy (in utero), around the time of delivery (labor and birth), and after birth through breast milk. The amount of virus in the mother’s blood, her viral load, largely drives the risk. When a mother takes combination antiretroviral therapy and achieves viral suppression, the virus circulating in the blood drops dramatically, which greatly reduces the chance that the baby will become infected during pregnancy or delivery. Delivery strategies come into play when viral suppression isn’t fully achieved or is incomplete; planning the delivery approach to minimize exposure—such as considering cesarean delivery before labor or membrane rupture in certain cases—helps lower transmission risk. After birth, breast milk can carry the virus, so breastfeeding carries a risk unless safe alternatives aren’t available; in settings with good formula access or in cases where maternal ART maintains suppression, the risk is further reduced, and infant-prophylaxis along with continued maternal ART can help protect the newborn.