| The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1--a meta-analysis of 15 prospective cohort studies. The International Perinatal HIV Group. | |
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MedLine Citation:
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PMID: 10099139 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To evaluate the relation between elective cesarean section and vertical transmission of human immunodeficiency virus type 1 (HIV-1), we performed a meta-analysis using data on individual patients from 15 prospective cohort studies. METHODS: North American and European studies of at least 100 mother-child pairs were included in the meta-analysis. Uniform definitions of modes of delivery were used. Elective cesarean sections were defined as those performed before onset of labor and rupture of membranes. Multivariate logistic-regression analysis was used to adjust for other factors known to be associated with vertical transmission. RESULTS: The primary analysis included data on 8533 mother-child pairs. After adjustment for receipt of antiretroviral therapy, maternal stage of disease, and infant birth weight, the likelihood of vertical transmission of HIV-1 was decreased by approximately 50 percent with elective cesarean section, as compared with other modes of delivery (adjusted odds ratio, 0.43; 95 percent confidence interval, 0.33 to 0.56). The results were similar when the study population was limited to those with rupture of membranes shortly before delivery. The likelihood of transmission was reduced by approximately 87 percent with both elective cesarean section and receipt of antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, as compared with other modes of delivery and the absence of therapy (adjusted odds ratio, 0.13; 95 percent confidence interval, 0.09 to 0.19). Among mother-child pairs receiving antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, rates of vertical transmission were 2.0 percent among the 196 mothers who underwent elective cesarean section and 7.3 percent among the 1255 mothers with other modes of delivery. CONCLUSIONS: The results of this meta-analysis suggest that elective cesarean section reduces the risk of transmission of HIV-1 from mother to child independently of the effects of treatment with zidovudine. |
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Authors:
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 340 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1999 Apr |
Date Detail:
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Created Date: 1999-04-01 Completed Date: 1999-04-01 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 977-87 Citation Subset: AIM; IM; X |
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| MeSH Terms | |
Descriptor/Qualifier:
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Anti-HIV Agents
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therapeutic use Birth Weight Cesarean Section / statistics & numerical data Cohort Studies Delivery, Obstetric* / statistics & numerical data Female HIV Infections / drug therapy, prevention & control, transmission* HIV-1* Humans Infant, Newborn Infectious Disease Transmission, Vertical / prevention & control, statistics & numerical data* Logistic Models Male Multivariate Analysis Pregnancy Pregnancy Complications, Infectious* / drug therapy Risk Factors Zidovudine / therapeutic use |
| Grant Support | |
ID/Acronym/Agency:
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N01 HD 43208/HD/NICHD NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents; 30516-87-1/Zidovudine |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1999 Apr 1;340(13):1032-3
[PMID:
10099146
]
N Engl J Med. 1999 Jul 15;341(3):205; author reply 206-7 [PMID: 10409036 ] N Engl J Med. 1999 Jul 15;341(3):205-6; author reply 206-7 [PMID: 10409037 ] N Engl J Med. 1999 Jul 15;341(3):206-7 [PMID: 10409038 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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