Maternal-infant HIV transmission and circumstances of delivery

Abstract

Objectives: Circumstances of delivery among children with acquired immunodeficiency syndrome (AIDS) were investigated to assess whether they were consistent with predictions that intrapartum factors affect the risk of maternal-infant human immunodeficiency virus (HIV) transmission.

Methods: Pediatric AIDS patients (maternal-infant transmission; n = 632) reported to the New York City Health Department through 1991 were compared with a series of infants born to predominantly uninfected women. For each case patient, five control subjects were selected and matched from birth certificate files. Hypothesized case-control comparisons for mode of delivery and preselected complications were tested.

Results: Compared with control subjects, case patients were less likely to have been delivered by cesarean section without complications (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.59, 1.01) and more likely to have been delivered with complications, whether delivery was by cesarean section (OR = 1.54; 95% CI = 0.98, 2.43) or vaginal (OR = 1.66; 95% CI = 1.15, 2.39).

Conclusions: Assuming that HIV-infected and uninfected women have comparable circumstances of delivery, conditional on sociomedical characteristics, these results suggest that intrapartum events may be associated with maternal-infant HIV transmission.