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

被引：64

作者：

Boer, K. ^{[1
,7
]}

England, K. ^{[1
]}

Godfried, M. H. ^{[1
,7
]}

Thorne, C. ^{[1
]}

Newell, M. L. ^{[1
]}

Mahdavi, S. ^{[1
]}

Giaquinto, C. ^{[2
]}

Rampon, O. ^{[2
]}

Mazza, A. ^{[2
]}

De Rossi, A. ^{[2
]}

Woerner, I. Grosch ^{[3
]}

Mok, J. ^{[4
]}

de Jose, Ma I. ^{[5
]}

Larru Martinez, B. ^{[5
]}

Ma Pena, J. ^{[5
]}

Gonzalez Garcia, J. ^{[5
]}

Arribas Lopez, J. R. ^{[5
]}

Garcia Rodriguez, M. C. ^{[5
]}

Asensi-Botet, F. ^{[6
]}

Otero, M. C. ^{[6
]}

Perez-Tamarit, D. ^{[6
]}

Scherpbier, H. J. ^{[7
]}

Kreyenbroek, M. ^{[7
]}

Godfried, M. H. ^{[1
,7
]}

Nellen, F. J. B. ^{[7
]}

Naver, L. ^{[8
,9
]}

Bohlin, A. B. ^{[8
,9
]}

Lindgren, S. ^{[8
,9
]}

Kaldma, A. ^{[8
,9
]}

Belfrage, E. ^{[8
,9
]}

Levy, J. ^{[10
]}

Barlow, P. ^{[10
]}

Manigart, Y. ^{[10
]}

Hainaut, M. ^{[10
]}

Goetghebuer, T. ^{[10
]}

Brichard, B. ^{[11
]}

De Bruycker, J. J. ^{[11
]}

Thiry, N. ^{[11
]}

Waterloos, H. ^{[11
]}

Viscoli, C. ^{[12
]}

De Maria, A. ^{[13
,14
]}

Bentivoglio, G. ^{[15
]}

Ferrero, S. ^{[15
]}

Gotta, C. ^{[15
]}

Mur, A. ^{[16
]}

Paya, A. ^{[16
]}

Lopez-Vilchez, M. A. ^{[16
]}

Carreras, R. ^{[16
]}

Valerius, N. H. ^{[17
]}

Rosenfeldt, V. ^{[17
]}

机构：

[1] UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England

[2] Univ Padua, I-35100 Padua, Italy

[3] Charite Virchow Klinikum, Berlin, Germany

[4] Royal Hosp Sick Children, Edinburgh EH9 1LF, Midlothian, Scotland

[5] Hosp Infantil La Paz, Madrid, Spain

[6] Hosp La Fe, E-46009 Valencia, Spain

[7] Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands

[8] Karolinska Univ Huspital, Huddinge, Sweden

[9] Karolinska Univ Huspital, Solna, Sweden

[10] Hosp St Pierre, Brussels, Belgium

[11] UCL St Luc, Brussels, Belgium

[12] Univ Genoa, Infect Dis Clin, Genoa, Italy

[13] Univ Genoa, Dept Internal Med, I-16126 Genoa, Italy

[14] IST, Ist Nazl Ric Canc, SS Infettivol, Genoa, Italy

[15] Univ Genoa, Dept Obstet & Gynecol, Neonatol Unit, Genoa, Italy

[16] Univ Autonoma Barcelona, Hosp Mar, E-08193 Barcelona, Spain

[17] Univ Copenhagen, Hvidovre Hosp, DK-2650 Hvidovre, Denmark

[18] Hosp Clin Barcelona, Barcelona, Spain

[19] Hosp St Joan de Deu, Barcelona, Spain

[20] Osped L Sacco, Milan, Italy

[21] Univ Milan, Dept Pediat, L Sacco Hosp, Milan, Italy

[22] IRCCS Burlo Garofolo, Trieste, Italy

[23] St Marys Hosp, London, England

[24] Chelsea & Westminster Hosp, London, England

[25] Univ Naples Federico II, Dept Pediat, Naples, Italy

[26] Univ Naples Federico II, Dept Obstet, Naples, Italy

[27] Univ Turin, Turin, Italy

[28] Natl Res Inst Mother & Child, Warsaw, Poland

[29] Med Univ Warsaw, Infect Dis Hosp, Warsaw, Poland

来源：

HIV MEDICINE | 2010年 / 11卷 / 06期

基金：

英国惠康基金;

关键词：

elective caesarean section; mode of delivery; mother-to-child transmission; prevention; IMMUNODEFICIENCY-VIRUS TYPE-1; COMBINATION ANTIRETROVIRAL THERAPY; LOW-BIRTH-WEIGHT; INFANT TRANSMISSION; UNITED-KINGDOM; INCREASED RISK; GUIDELINES; MANAGEMENT; RECOMMENDATIONS; COMPLICATIONS;

D O I：

10.1111/j.1468-1293.2009.00800.x

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

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.

引用

页码：368 / 378

页数：11

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