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. 2018 May;131(5):879-890.
doi: 10.1097/AOG.0000000000002566.

Changing Patterns and Factors Associated With Mode of Delivery Among Pregnant Women With Human Immunodeficiency Virus Infection in the United States

Kartik K Venkatesh  1 , Leavitt Morrison, Elizabeth G Livingston, Alice Stek, Jennifer S Read, David E Shapiro, Ruth E Tuomala
Affiliations

Changing Patterns and Factors Associated With Mode of Delivery Among Pregnant Women With Human Immunodeficiency Virus Infection in the United States

Kartik K Venkatesh et al. Obstet Gynecol. 2018 May.

Abstract

Objective: To describe patterns and factors associated with mode of delivery among pregnant women with human immunodeficiency virus (HIV) infection in the United States in relation to evolving HIV-in-pregnancy guidelines.

Methods: We conducted an analysis of two observational studies, Pediatric AIDS Clinical Trials Group and International Maternal Pediatric Adolescent AIDS Clinical Trials Network Protocol P1025, which enrolled pregnant women with HIV infection from 1998 to 2013 at more than 60 U.S. acquired immunodeficiency syndrome clinical research sites. Multivariable analyses of factors associated with an HIV-indicated cesarean delivery (ie, for prevention of mother-to-child transmission) compared with other indications were conducted and compared according to prespecified time periods of evolving HIV-in-pregnancy guidelines: 1998-1999, 2000-2008, and 2009-2013.

Results: Among 6,444 pregnant women with HIV infection, 21% delivered in 1998-1999, 58% in 2000-2008, and 21% in 2009-2013; 3,025 (47%) delivered by cesarean. Cesarean delivery increased from 30% in 1998 to 48% in 2013. Of all cesarean deliveries, repeat cesarean deliveries increased from 16% in 1998 to 42% in 2013; HIV-indicated cesarean deliveries peaked at 48% in 2004 and then dropped to 12% by 2013. In multivariable analyses, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, a plasma viral load 500 copies/mL or greater, and delivery between 37 and 40 weeks of gestation increased the likelihood of an HIV-indicated cesarean delivery. In analyses by time period, an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, and a plasma viral load of 500 copies/mL or greater were progressively more likely to be associated with an HIV-indicated cesarean delivery over time.

Conclusion: Almost 50% of pregnant women with HIV infection underwent cesarean delivery. Over time, the rate of repeat cesarean deliveries increased, whereas the rate of HIV-indicated cesarean deliveries decreased; cesarean deliveries were more likely to be performed in women at high risk of mother-to-child transmission. These findings reinforce the need for both early diagnosis and treatment of HIV infection in pregnancy and the option of vaginal delivery after cesarean among pregnant women with HIV infection.

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Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal’s requirements for authorship.

Figures

Figure 1
Figure 1
Cesarean delivery rate among women infected with human immunodeficiency virus (HIV) in the Pediatric AIDS Clinical Trials Group (PACTG) or International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) cohorts compared to all U.S. women from 1998–2013. Vertical gray lines indicate guideline change. U.S. cesarean delivery rate obtained from Osterman MJ, Martin JA. Natl Vital Stat Rep 2014;63:1–16. Available at: https://www.cdc.gov/nchs/fastats/delivery.htm. Accessed November 12, 2017.
Figure 2
Figure 2
Indications for cesarean delivery among women infected with human immunodeficiency virus (HIV) in the Pediatric AIDS Clinical Trials Group (PACTG) or International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) cohorts from 1998–2013. Vertical gray lines indicate guideline change. The above data is presented in table format in Appendix 4 (available online at http://links.lww.com/xxx).
See this image and copyright information in PMC

References

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