The fact that zidovudine therapy can prevent perinatal transmission of HIV infection strongly supports the need to screen for HIV during pregnancy. Controversy continues to revolve around which testing strategy offers the benefits of zidovudine to the greatest number of infants while still allowing the mother some degree of autonomy in making her own health care decisions. Screening based on patient-reported risk factors has repeatedly been shown to exclude many seropositive women. Voluntary testing has had inconsistent results, and mandatory testing may discourage women from getting the prenatal care they need. Despite the controversy, HIV testing and education should be recommended to all pregnant women. Counseling should be geared to the educational level of the patient, and risk-factor reduction is an important component of counseling. Health care providers must be prepared to address the social as well as the medical ramifications of a diagnosis of HIV infection for both the mother and the unborn child.