Document Detail


Mode of delivery and infant respiratory morbidity among infants born to HIV-1-infected women.
MedLine Citation:
PMID:  20664394     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To estimate risk of infant respiratory morbidity associated with cesarean delivery before labor and ruptured membranes among HIV-1-infected women.
METHODS: In a prospective cohort study of HIV-1-infected women and their infants, mode of delivery was determined by clinicians at the participating sites. For this analysis, "elective cesarean delivery" was defined as any cesarean delivery, regardless of gestational age, without labor and with duration of ruptured membranes of less than 5 minutes. Nonelective cesarean deliveries were those performed after the onset of labor, rupture of membranes, or both. Vaginal delivery included normal spontaneous and instrument deliveries. Associations between mode of delivery and infant respiratory morbidity were assessed using chi or Fisher's exact test. Adjusted odds of respiratory distress syndrome by delivery mode were assessed using multivariable logistic regression.
RESULTS: Among 1,194 mother-infant pairs, there were significant differences according to mode of delivery in median gestational age (weeks) at delivery (vaginal, n=566, median=38.8; nonelective cesarean, n=216, median=38.0; and elective cesarean, n=412, median 38.1; P<.001) and incidence of respiratory distress syndrome (vaginal, n=9, 1.6%, reference; nonelective cesarean, n=16, 7.4%; elective cesarean, n=18; 4.4%; (P<.001). In analyses adjusted for gestational age and birth weight, mode of delivery was not statistically significantly associated with infant respiratory distress syndrome (P=.10), although a trend toward an increased risk of respiratory distress syndrome among infants delivered by cesarean was suggested (nonelective cesarean adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 0.95-5.67; elective cesarean OR 2.56, 95% CI 1.01-6.48).
CONCLUSION: Respiratory distress syndrome rates associated with elective cesarean delivery among HIV-1-infected women are low, comparable with published rates among uninfected women. There is minimal neonatal respiratory morbidity risk in near-term infants born by elective cesarean delivery to HIV-1-infected women.
LEVEL OF EVIDENCE: II.
Authors:
Elizabeth G Livingston; Yanling Huo; Kunjal Patel; Susan B Brogly; Ruth Tuomala; Gwendolyn B Scott; Arlene Bardeguez; Alice Stek; Jennifer S Read;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  116     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-08-17     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  335-43     Citation Subset:  AIM; IM    
Affiliation:
Duke University, Durham, North Carolina 27710, USA. livin001@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Cesarean Section / adverse effects*
Delivery, Obstetric
Female
HIV Infections / complications*
HIV-1*
Humans
Infant, Newborn
Pregnancy
Pregnancy Complications, Infectious*
Prospective Studies
Respiratory Distress Syndrome, Newborn / epidemiology*,  etiology
Risk Factors
Young Adult
Grant Support
ID/Acronym/Agency:
HHSN267200800001C//PHS HHS; HHSN272200800014C//PHS HHS; N01-DK-8-0001/DK/NIDDK NIH HHS; N01-HD-3-3365/HD/NICHD NIH HHS; U01 AI068616/AI/NIAID NIH HHS; U01 AI068632-03/AI/NIAID NIH HHS; U01AI068632/AI/NIAID NIH HHS
Investigator
Investigator/Affiliation:
Charmane Calilap-Bernardo / ; James Oleske / ; Linda Bettica / ; Mark Mirochnick / ; Desiree Jones / ; Sandra Burchett / ; Catherine Kneut / ; Arlene Buck / ; Audra Deveikis / ; Susan Marks / ; Margaret A Keller / ; Judy Hayes / ; Yolanda Gonzalez / ; Spring Wettgen / ; John Farley / ; Georgine Price / ; Mary E Paul / ; Shelley Buschur / ; Chivon D McMullen-Jackson / ; Norma Cooper / ; Brenda Wolfe / ; Jessica Shore / ; Kenneth Boyer / ; Maureen Haak / ; James B McAuley / ; Elizabeth Jones / ; Linda Walsh / ; John Marcinak / ; Daniel Johnson / ; Dominika Kowalski / ; Brenda Wolfe / ; Diane Tose / ; Seydi Vazquez / ; Charles Mitchell / ; Amanda Cotter / ; Erika Lopez / ; Claudia Florez / ; Diane Wara / ; Deborah Cohan / ; Nicole Tilton / ; Mica Muscat / ; Maureen Shannon / ; Andrew D Hull / ; Rolando Viani / ; Stephen Spector / ; Mary Caffery / ; Carole Mathison / ; John Swetnam / ; Joan Wilson / ; Margaret Donnelly / ; Maryam Minter / ; Sandra Deygoo / ; Aditya Kaul / ; William Borkowsky / ; David Garry / ; Mindy Katz / ; Raphaelle Auguste / ; Jane Hitti / ; Michele Acker / ; Mark Vajaranant / ; Harriett Wittert / ; Midnela Acevedo / ; Elvia Perez / ; Warren A Andiman / ; B Joyce Simpson / ; Leslie Hurst / ; Sharon Nachman / ; Jennifer Griffin / ; Theodore Jones / ; Tameka Watson / ; Ernestine Brown / ; Sohail Rana / ; Caroline Reed / ; Meseret Deressa / ; Folasade Akereyeni / ; LaShonda Spencer / ; James Homans / ; Michael Neely / ; Francoise Kramer / ; Mobeen H Rathore / ; Isaac Delke / ; Carol Salbenblatt / ; Kay Kinzie / ; Jennifer Dunn / ; Molly King / ; Ana M Puga / ; Guillermo Talero / ; Amy Inman / ; Katherine Knapp / ; Nehali Patel / ; Jill Utech / ; Pam Finnie / ; Ruth Santos / ; Irma Febo / ; Jenny Guittierez / ; Rodney Wright / ; Mavis Dummitt / ; Murli Purswani / ; Katherine Luzuriaga / ; Sharon Cormier / ; Barbara W Stechenberg / ; Donna Fisher / ; Eileen Theroux / ; Maripat Toye / ; Chi Chi Dola / ; Robert Maupin / ; Sheila Bradford / ; Yvonne Luster / ; Marilyn Crain / ; Alan Tita / ; Sharan Robbins / ; Mickey Parks / ; Allison Agwu / ; Jennifer Chang / ; Todd Noletto / ; Joan Bess / ; Juan Salazar / ; Gail Karas / ; Andrew Wiznia / ; David Garry / ; Francisco Reinoso / ; Karen Kassen / ; H J Moallem / ; E Handelsman / ; J Kaye / ; D Swindell / ; Yvonne Bryson / ; Jaime Deville / ; Karin Nielsen / ; Nicole Falgout / ; Leonard Weiner / ; Kathie Contello / ; Wendie Holz / ; Maureen Butler /
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