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Volume 340:977-987 April 1, 1999 Number 13 Next

	Full Text PDF Editorial by Riley, L. E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

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.

Source Information

On behalf of the Steering Committee, Jennifer S. Read, M.D., M.P.H., assumes responsibility for the overall content of the manuscript. Presented in part at the 12th International Conference on AIDS, Geneva, Switzerland, June 1998 (Abstract 23603LB).

Address reprint requests to Dr. Read at the Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Executive Bldg., Rm. 4B11F, 6100 Executive Blvd. MSC 7510, Bethesda, MD 20892-7510.

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Mode of Delivery and the Risk of Vertical Transmission of HIV-1
Landers D. V., Duarte G., Beckerman K. P., Morris A. B., Stek A., Gelber R. D., Shapiro D. E., Read J. S., The International Perinatal HIV Group
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N Engl J Med 1999; 341:205-207, Jul 15, 1999. Correspondence

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• (1999). Elective Cesarean Reduces Perinatal Transmission. AIDS Clin Care 1999: 4-4 [Full Text]  
• (1999). Elective Cesarean Delivery to Prevent Neonatal HIV Infection?. JWatch Women's Health 1999: 12-12 [Full Text]  
• (1999). C-Section Limits Mother-Child HIV Transmission. JWatch General 1999: 2-2 [Full Text]  
• Riley, L. E., Greene, M. F. (1999). Elective Cesarean Delivery to Reduce the Transmission of HIV. NEJM 340: 1032-1033 [Full Text]