       Document 0442
 DOCN  M9640442
 TI    Mode of delivery and gestational age influence perinatal HIV-1
       transmission. Italian Register for HIV Infection in Children.
 DT    9604
 AU    Tovo PA; de Martino M; Gabiano C; Galli L; Cappello N; Ruga E; Tulisso
       S; Vierucci A; Loy A; Zuccotti GV; et al; Department of Pediatrics,
       University of Turin, Italy.
 SO    J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jan 1;11(1):88-94.
       Unique Identifier : AIDSLINE MED/96130052
 AB    Some data suggest that cesarean section reduces mother-to-child HIV-1
       transmission. To assess the influence of mode of delivery and other
       maternal and infant factors on the rate of transmission, we analyzed the
       data of 1,624 children prospectively followed from birth. Of these, at
       the last visit 1,033 were > 18 months of age or would have been had they
       not died of HIV-related illness. Among the 975 first singleton children,
       180 [18.5%; 95% confidence limits (CL), 16.1-20.9] acquired infection,
       as did 8 of 56 (14.3%; 95% CL, 5.1-23.5) second-born children.
       Multivariate stepwise analysis showed that vaginal delivery and
       development of symptoms in the mother were significantly and
       independently associated with a higher transmission rate (vaginal
       delivery; odds ratio, 1.69; 95% CL, 1.14-2.5; symptoms: odds ratio,
       1.61; 95% CL, 1.12-2.3). In contrast, a history of maternal drug use,
       birth weight, breast-feeding (only 37 infants were breast-fed), and
       child's sex did not have a significant impact on viral transmission. The
       percentage of infected children was highest (30.7%) among very premature
       infants (< or = 32 weeks of gestation); this significant trend
       subsequently decreased to 11.9% at the week 42 (p < 0.001), suggesting a
       parallel reduction in peripartum transmission. The reduced rate of
       infection observed in infants born by cesarean section underlines the
       urgent need for randomized controlled trials to evaluate the protective
       role of surgical delivery in preventing perinatal HIV-1 transmission.
 DE    Birth Weight  Child, Preschool  Delivery/*METHODS  *Disease
       Transmission, Vertical  Female  *Gestational Age  Human  HIV
       Infections/*TRANSMISSION  HIV Seropositivity/TRANSMISSION  *HIV-1
       Infant  Male  Maternal-Fetal Exchange  Multivariate Analysis  Odds Ratio
       Parity  Pregnancy  Prospective Studies  Questionnaires  Risk Factors
       Support, Non-U.S. Gov't  JOURNAL ARTICLE  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

