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. 2010 Jul 1;11(6):368-78.
doi: 10.1111/j.1468-1293.2009.00800.x. Epub 2010 Jan 4.

Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe

European Collaborative Study; K Boer, K England, M H Godfried, C Thorne
Collaborators

Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe

European Collaborative Study et al. HIV Med. .

Abstract

Objectives: The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations between mode of delivery and mother-to-child transmission (MTCT).

Methods: The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their infants prospectively followed. Data on 5238 mother-child pairs (MCPs) enrolled in Western European ECS sites between 1985 and 2007 were analysed.

Results: The elective CS rate increased from 16% in 1985-1993 to 67% in 1999-2001, declining to 51% by 2005-2007. In 2002-2004, 10% of infants were delivered vaginally, increasing to 34% by 2005-2007. During the HAART era, women in Belgium, the United Kingdom and the Netherlands were less likely to deliver by elective CS than those in Italy and Spain [adjusted odds ratio (AOR) 0.07; 95% confidence interval (CI) 0.04-0.12]. The MTCT rate in 2005-2007 was 1%. Among MCPs with maternal HIV RNA<400 HIV-1 RNA copies/mL (n=960), elective CS was associated with 80% decreased MTCT risk (AOR 0.20; 95% CI 0.05-0.65) adjusting for HAART and prematurity. Two infants born to 559 women with viral loads <50 copies/mL were infected, one of whom was delivered by elective CS (MTCT rate 0.4%; 95% CI 0.04-1.29).

Conclusions: Our findings suggest that elective CS prevents MTCT even at low maternal viral loads, but the study was insufficiently powered to enable a conclusion to be drawn as to whether this applies for viral loads <50 copies/mL. Diverging mode of delivery patterns in Europe reflect uncertainties regarding the risk-benefit balance of elective CS for women on successful HAART.

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Figures

Figure 1
Figure 1. Trends in use of (HA)ART, mode of delivery and MTCT*
* in MCPs with known child’s infection; the three vertical blue lines mark from left to right the publication year of the ACTG 076 trial [10 ], the start of the HAART era and the publication of the European Mode of Delivery trial [8]
Figure 2
Figure 2. Mode of delivery in three Western European regions*
* for 4309 MCPs with known child’s infection status
See this image and copyright information in PMC

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References

    1. Boer K, Nellen JF, Patel D, Timmermans S, Tempelman C, Wibaut M, et al. The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery. BJOG. 2007;114(2):148–155. - PubMed
    1. European Collaborative Study The mother-to-child HIV transmission epidemic in Europe: evolving in the East and established in the West. AIDS. 2006;20(10):1419–1427. - PubMed
    1. Townsend CL, Cortina-Borja M, Peckham CS, de RA, Lyall H, Tookey PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS. 2008;22(8):973–981. - PubMed
    1. Warszawski J, Tubiana R, Le CJ, Blanche S, Teglas JP, Dollfus C, et al. Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS. 2008;22(2):289–299. - PubMed
    1. European Collaborative Study Caesarean section and risk of vertical transmission of HIV-1 infection. Lancet. 1994;343(8911):1464–1467. - PubMed

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