Known or Suspected Pregnancy in the HCW
Pregnancy should not preclude the use of optimal PEP regimens, and PEP should not be denied to an HCW solely on the basis of pregnancy. However, as discussed previously, an occupationally exposed pregnant HCW must be provided with full information about what is known and not known regarding the potential benefits and risks associated with use of the antiretroviral drugs to her and her fetus for her to make an informed decision regarding the use of PEP. The choice of antiretroviral drugs to use for PEP in pregnant HCWs is complicated by the potential need to alter dosing because of physiologic changes associated with pregnancy and the potential for short- or long-term effects on the fetus and newborn. Thus, considerations that should be discussed with a pregnant HCW include the potential risk for HIV transmission based on the type of exposure; the stage of pregnancy (the first trimester being the period of maximal organogenesis and risk for teratogenesis); and what is known about the pharmacokinetics, safety, and tolerability of the drug or combination of drugs in pregnancy.