Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe
Por:
Boer, K., England, K., Godfried, M. H., Thorne, C., Newell, M. L., Mahdavi, S., Giaquinto, C., Rampon, O., Mazza, A., De Rossi, A., Woerner, I. Grosch, Mok, J., de Jose, Ma I., Larru Martinez, B., Ma Pena, J., Gonzalez Garcia, J., Arribas Lopez, J. R., Garcia Rodriguez, M. C., Asensi-Botet, F., Otero, M. C., Perez-Tamarit, D., Scherpbier, H. J., Kreyenbroek, M., Godfried, M. H., Nellen, F. J. B., Naver, L., Bohlin, A. B., Lindgren, S., Kaldma, A., Belfrage, E., Levy, J., Barlow, P., Manigart, Y., Hainaut, M., Goetghebuer, T., Brichard, B., De Bruycker, J. J., Thiry, N., Waterloos, H., Viscoli, C., De Maria, A., Bentivoglio, G., Ferrero, S., Gotta, C., Mur, A., Paya, A., Lopez-Vilchez, M. A., Carreras, R., Valerius, N. H., Rosenfeldt, V., Coll, O., Suy, A., Perez, J. M., Fortuny-Guasch C, Boguña-Ponsa JM, Savasi, V., Fiore, S., Crivelli, M., Vigano, A., Giacomet, V., Cerini, C., Raimondi, C., Zuccotti, G., Alberico, S., Tropea, M., Businelli, C., Taylor, G. P., Lyall, E. G. H., Penn, Z., Buffolano, W., Tiseo, R., Martinelli, P., Sansone, M., Maruotti, G., Agangi, A., Tibaldi, C., Marini, S., Masuelli, G., Benedetto, C., Niemiec, T., Marczynska, M., Dobosz, S., Popielska, J., Oldakowska, A., Malyuta, R., Semenenko, I., Pilipenko, T. and European Collaborative Study
Publicada:
1 jul 2010
Resumen:
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.
Filiaciones:
Boer, K.:
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
England, K.:
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Godfried, M. H.:
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
Thorne, C.:
(Reprint Author), UCL Inst Child Hlth, MRC Ctr Epidemiol Child Hlth, 30 Guilford St, London WC1N 1EH, England
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Newell, M. L.:
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Mahdavi, S.:
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Giaquinto, C.:
Univ Padua, I-35100 Padua, Italy
Rampon, O.:
Univ Padua, I-35100 Padua, Italy
Mazza, A.:
Univ Padua, I-35100 Padua, Italy
De Rossi, A.:
Univ Padua, I-35100 Padua, Italy
Woerner, I. Grosch:
Charite Virchow Klinikum, Berlin, Germany
Mok, J.:
Royal Hosp Sick Children, Edinburgh EH9 1LF, Midlothian, Scotland
de Jose, Ma I.:
Hosp Infantil La Paz, Madrid, Spain
Larru Martinez, B.:
Hosp Infantil La Paz, Madrid, Spain
Ma Pena, J.:
Hosp Infantil La Paz, Madrid, Spain
Gonzalez Garcia, J.:
Hosp Infantil La Paz, Madrid, Spain
Arribas Lopez, J. R.:
Hosp Infantil La Paz, Madrid, Spain
Garcia Rodriguez, M. C.:
Hosp Infantil La Paz, Madrid, Spain
Asensi-Botet, F.:
Hosp La Fe, E-46009 Valencia, Spain
Otero, M. C.:
Hosp La Fe, E-46009 Valencia, Spain
Perez-Tamarit, D.:
Hosp La Fe, E-46009 Valencia, Spain
Scherpbier, H. J.:
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
Kreyenbroek, M.:
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
Godfried, M. H.:
UCL Inst Child Hlth, ECS Coordinating Ctr, London WC1N 1EH, England
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
Nellen, F. J. B.:
Univ Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, Netherlands
Naver, L.:
Karolinska Univ Huspital, Huddinge, Sweden
Karolinska Univ Huspital, Solna, Sweden
Bohlin, A. B.:
Karolinska Univ Huspital, Huddinge, Sweden
Karolinska Univ Huspital, Solna, Sweden
Lindgren, S.:
Karolinska Univ Huspital, Huddinge, Sweden
Karolinska Univ Huspital, Solna, Sweden
Kaldma, A.:
Karolinska Univ Huspital, Huddinge, Sweden
Karolinska Univ Huspital, Solna, Sweden
Belfrage, E.:
Karolinska Univ Huspital, Huddinge, Sweden
Karolinska Univ Huspital, Solna, Sweden
Levy, J.:
Hosp St Pierre, Brussels, Belgium
Barlow, P.:
Hosp St Pierre, Brussels, Belgium
Manigart, Y.:
Hosp St Pierre, Brussels, Belgium
Hainaut, M.:
Hosp St Pierre, Brussels, Belgium
Goetghebuer, T.:
Hosp St Pierre, Brussels, Belgium
Brichard, B.:
UCL St Luc, Brussels, Belgium
De Bruycker, J. J.:
UCL St Luc, Brussels, Belgium
Thiry, N.:
UCL St Luc, Brussels, Belgium
Waterloos, H.:
UCL St Luc, Brussels, Belgium
Viscoli, C.:
Univ Genoa, Infect Dis Clin, Genoa, Italy
De Maria, A.:
Univ Genoa, Dept Internal Med, I-16126 Genoa, Italy
IST, Ist Nazl Ric Canc, SS Infettivol, Genoa, Italy
Bentivoglio, G.:
Univ Genoa, Dept Obstet & Gynecol, Neonatol Unit, Genoa, Italy
Ferrero, S.:
Univ Genoa, Dept Obstet & Gynecol, Neonatol Unit, Genoa, Italy
Gotta, C.:
Univ Genoa, Dept Obstet & Gynecol, Neonatol Unit, Genoa, Italy
Mur, A.:
Univ Autonoma Barcelona, Hosp Mar, E-08193 Barcelona, Spain
Paya, A.:
Univ Autonoma Barcelona, Hosp Mar, E-08193 Barcelona, Spain
Lopez-Vilchez, M. A.:
Univ Autonoma Barcelona, Hosp Mar, E-08193 Barcelona, Spain
Carreras, R.:
Univ Autonoma Barcelona, Hosp Mar, E-08193 Barcelona, Spain
Valerius, N. H.:
Univ Copenhagen, Hvidovre Hosp, DK-2650 Hvidovre, Denmark
Rosenfeldt, V.:
Univ Copenhagen, Hvidovre Hosp, DK-2650 Hvidovre, Denmark
Coll, O.:
Hosp Clin Barcelona, Barcelona, Spain
Suy, A.:
Hosp Clin Barcelona, Barcelona, Spain
Perez, J. M.:
Hosp Clin Barcelona, Barcelona, Spain
Fortuny-Guasch C:
Hosp St Joan de Deu, Barcelona, Spain
Boguña-Ponsa JM:
Hosp St Joan de Deu, Barcelona, Spain
Savasi, V.:
Osped L Sacco, Milan, Italy
Fiore, S.:
Osped L Sacco, Milan, Italy
Crivelli, M.:
Osped L Sacco, Milan, Italy
Vigano, A.:
Univ Milan, Dept Pediat, L Sacco Hosp, Milan, Italy
Giacomet, V.:
Univ Milan, Dept Pediat, L Sacco Hosp, Milan, Italy
Cerini, C.:
Univ Milan, Dept Pediat, L Sacco Hosp, Milan, Italy
Raimondi, C.:
Univ Milan, Dept Pediat, L Sacco Hosp, Milan, Italy
Zuccotti, G.:
Univ Milan, Dept Pediat, L Sacco Hosp, Milan, Italy
Alberico, S.:
IRCCS Burlo Garofolo, Trieste, Italy
Tropea, M.:
IRCCS Burlo Garofolo, Trieste, Italy
Businelli, C.:
IRCCS Burlo Garofolo, Trieste, Italy
Taylor, G. P.:
St Marys Hosp, London, England
Lyall, E. G. H.:
St Marys Hosp, London, England
Penn, Z.:
Chelsea & Westminster Hosp, London, England
Buffolano, W.:
Univ Naples Federico 2, Dept Pediat, Naples, Italy
Tiseo, R.:
Univ Naples Federico 2, Dept Pediat, Naples, Italy
Martinelli, P.:
Univ Naples Federico 2, Dept Obstet, Naples, Italy
Sansone, M.:
Univ Naples Federico 2, Dept Obstet, Naples, Italy
Maruotti, G.:
Univ Naples Federico 2, Dept Obstet, Naples, Italy
Agangi, A.:
Univ Naples Federico 2, Dept Obstet, Naples, Italy
Tibaldi, C.:
Univ Turin, Turin, Italy
Marini, S.:
Univ Turin, Turin, Italy
Masuelli, G.:
Univ Turin, Turin, Italy
Benedetto, C.:
Univ Turin, Turin, Italy
Niemiec, T.:
Natl Res Inst Mother & Child, Warsaw, Poland
Marczynska, M.:
Med Univ Warsaw, Infect Dis Hosp, Warsaw, Poland
Dobosz, S.:
Med Univ Warsaw, Infect Dis Hosp, Warsaw, Poland
Popielska, J.:
Med Univ Warsaw, Infect Dis Hosp, Warsaw, Poland
Oldakowska, A.:
Med Univ Warsaw, Infect Dis Hosp, Warsaw, Poland
Green Accepted, Bronze
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