PrEP and pregnancy:
what Nigerian women need to know.
Can you take PrEP while pregnant or trying to conceive? What happens if you become pregnant while on PrEP? Here’s everything you need to know, clearly, and without unnecessary alarm.
Medically reviewed by Jude Ozioko, Pharmacist (PCN 024035) • Last reviewed October 2026
HIV prevention matters a great deal during pregnancy, not just for the mother but for the child. HIV acquired during pregnancy or while breastfeeding carries a high risk of mother-to-child transmission, which is entirely preventable with the right care. For HIV-negative women at ongoing risk of HIV exposure, PrEP is one of the most powerful tools available.
Yet many Nigerian women, and many healthcare providers, are uncertain about whether PrEP is safe during pregnancy, what to do if pregnancy happens while on PrEP, and how to navigate conception in a serodiscordant couple where one partner is HIV-positive. This article answers all of those questions.
What the evidence says about PrEP in pregnancy.
Oral PrEP, the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC), is recommended by the World Health Organization for HIV-negative pregnant women at ongoing risk of HIV. This isn’t a cautious hedge. It’s an active recommendation based on substantial evidence.
Large studies have followed HIV-negative women using TDF/FTC during pregnancy and found no significant increase in birth defects, premature birth, or adverse outcomes for the baby compared with women not on PrEP. The WHO supports PrEP use during pregnancy and breastfeeding precisely because the risk of HIV acquisition during these periods, and the consequences of mother-to-child transmission, outweigh any theoretical risk from the medication.
A gynaecologist, obstetrician, or doctor managing your antenatal care should know you’re on PrEP. In the vast majority of cases they’ll support continuing it. If a provider advises stopping PrEP during pregnancy without a specific clinical reason, it’s reasonable to ask them to explain their thinking and to seek a second opinion from a pharmacist or HIV-specialist physician.
Your situation and what PrEP guidance applies.
HIV-negative and pregnant with a partner of unknown status
If your partner’s HIV status is unknown and you’re having unprotected sex during pregnancy, PrEP is recommended. HIV acquired during pregnancy carries a much higher risk of transmission to the baby than HIV acquired before conception.
HIV-negative in a serodiscordant relationship, trying to conceive
If your partner is HIV-positive and not yet undetectable, or you simply want extra protection during the conception period, PrEP lets you attempt conception while reducing your HIV risk. Talk to a doctor or our team about the best timing around ovulation.
Already pregnant and on PrEP when pregnancy is discovered
If you become pregnant while taking PrEP, don’t stop it without speaking to our team, your doctor, or your obstetrician first. The evidence doesn’t support stopping PrEP in early pregnancy as a precaution. Continuing is generally the right approach if your risk profile warrants it.
HIV-negative, pregnant, and partner is undetectable on ART
If your partner is confirmed HIV-positive but consistently undetectable on treatment, the U=U principle means HIV is not passed on through sex. PrEP here isn’t clinically required, but some couples choose it for extra reassurance. Talk it through with our team or your obstetrician.
How to conceive safely when one partner is HIV-positive.
One of the most emotionally complex situations in HIV prevention is wanting to have a child when one partner is HIV-positive. For many Nigerian couples in this situation, the fear of HIV transmission has historically meant avoiding attempts at conception entirely. Modern HIV medicine has changed this picture significantly.
If the HIV-positive partner is undetectable on treatment.
When the HIV-positive partner has a confirmed undetectable viral load through consistent antiretroviral therapy, the U=U principle applies. They cannot transmit HIV to their partner through sex. Conception through unprotected sex during the fertile window carries no meaningful HIV risk in this context. The HIV-negative partner doesn’t strictly need PrEP for HIV protection, though some couples choose it for extra reassurance. This conversation should involve the HIV-positive partner’s doctor or HIV physician to confirm viral suppression and advise on timing.
If the HIV-positive partner is not yet virally suppressed.
Where the HIV-positive partner is on treatment but not yet confirmed undetectable, or isn’t yet on treatment, PrEP for the HIV-negative partner substantially reduces the risk of transmission during unprotected sex around ovulation. The HIV-positive partner should also be working with their doctor or HIV physician to reach viral suppression as fast as possible, ideally before conception attempts begin. Limiting unprotected sex to the fertile window, while staying on PrEP, is the standard clinical approach here.
Ongoing PrEP use through pregnancy and beyond.
The WHO recommends that HIV-negative women who are at ongoing HIV risk continue PrEP throughout pregnancy and for the duration of breastfeeding. This is because HIV acquisition during breastfeeding also carries transmission risk to the infant through breast milk.
Routine PrEP monitoring continues during pregnancy: an HIV test every 3 months and, for the daily pill, a kidney function check every 6 to 12 months. Your obstetrician or the doctor managing your antenatal care should know you’re on PrEP, and your antenatal HIV test results form part of the normal follow-up. Our team can coordinate refills and monitoring reminders throughout your pregnancy.
If you stop breastfeeding and your HIV risk changes, the decision about whether to continue PrEP beyond breastfeeding can be reviewed with our team or your doctor at that point. Not sure which PrEP option suits you? Compare them in which PrEP is right for you.
Questions about PrEP and reproductive health.
QDoes PrEP affect fertility or the ability to get pregnant?
No. There is no evidence that oral PrEP (TDF/FTC) affects fertility, menstrual cycles, or the ability to conceive. Clinical studies that followed women on PrEP who were trying to conceive found no reduction in conception rates compared to those not on PrEP. If you have concerns about fertility beyond HIV prevention, a gynaecologist or reproductive health specialist is the right person to consult.
QI found out I was pregnant while on PrEP. Should I stop immediately?
Don’t stop PrEP without speaking to our team, your doctor, or your obstetrician first. The evidence doesn’t support stopping PrEP in early pregnancy as a precaution. The WHO actively recommends continuing it for women at ongoing HIV risk. Your provider will review your specific situation and advise. Stopping abruptly without guidance could expose you to HIV at a particularly vulnerable time.
QCan I use injectable PrEP (CAB-LA or lenacapavir) during pregnancy?
The WHO says CAB-LA can be used during pregnancy and breastfeeding, and early data on lenacapavir from women who became pregnant during trials are reassuring. The daily pill still has the most safety data in pregnancy, so many women choose it if they are planning a pregnancy or already pregnant.
If you become pregnant while on an injection, don’t stop it on your own. Both injections stay in the body for a long time, and stopping without a plan can leave you unprotected. Talk to our team or your doctor as soon as pregnancy is confirmed, so you can decide together whether to continue or switch.
QMy antenatal nurse says PrEP is not safe in pregnancy. What should I do?
This reflects outdated guidance or incomplete knowledge of the current WHO recommendations. The WHO explicitly recommends PrEP for HIV-negative pregnant women at ongoing HIV risk, based on substantial evidence of safety. Ask your nurse or doctor to review the current WHO consolidated guidelines on HIV prevention. You may also seek a second opinion from a pharmacist or HIV physician. Don’t stop PrEP on the basis of a single provider’s advice without getting that second opinion, especially if your HIV risk is ongoing.
Pregnant or trying to conceive and have questions about PrEP?
Our team can advise on PrEP safety during pregnancy, serodiscordant conception, and ongoing monitoring, all via WhatsApp, any time of day or night, without a hospital visit.
Talk to Our Team →Protecting yourself during pregnancy protects your baby too.
PrEP is safe in pregnancy. The evidence is clear. The WHO recommends it. You deserve to know that.
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