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

• Published in: HIV medicine Vol. 11; no. 6; pp. 368 - 378
• Main Authors: Boer, K, England, K, Godfried, M H, Thorne, C
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2010
• Subjects: Adult; Antiretroviral Therapy, Highly Active - statistics & numerical data; Cesarean Section - statistics & numerical data; Delivery, Obstetric - methods; Delivery, Obstetric - trends; elective caesarean section; Epidemiologic Methods; Europe - epidemiology; Female; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Medicin och hälsovetenskap; mode of delivery; mother‐to‐child transmission; Pregnancy; Pregnancy Complications, Infectious; Premature Birth - epidemiology; Prenatal Care - methods; prevention; Reverse Transcriptase Inhibitors - therapeutic use; Substance Abuse, Intravenous - complications; Viral Load; Young Adult; Zidovudine - therapeutic use
• ISSN: 1464-2662; 1468-1293; 1468-1293
• DOI: 10.1111/j.1468-1293.2009.00800.x

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.