Results of NICHD meta-analysis
The National Institute of Child Health and Human Development (NICHD) researchers performed a meta-analysis of patients in 15 prospective cohort studies.
The analysis included 8,533 mother-child pairs from five European studies and 10 North American studies.
According to results published in the article on the New England Journal of Medicine Web site, following adjustments made for antiretroviral therapy, maternal stage of disease, and infant birthweight, the likelihood of vertical transmission of HIV-1 was reduced by 50% with elective cesarean when compared with other modes of delivery.
Elective cesareans were defined as those performed before onset of labor and rupture of membranes. The likelihood of transmission was reduced by approximately 87% 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.
The mothers included in the study were divided into four groups:
• those who had elective cesarean section;
• those who had a cesarean after rupture of the membranes and/or after labor began;
• those who delivered vaginally with assistance from forceps or vacuum suction;
• those who delivered vaginally with neither.
The main analysis compared the likelihood of HIV infection among 857 children whose mothers delivered by cesarean section to that of 7,676 children delivered using other methods.
Of the 5,944 mothers who did not receive antiretroviral therapy during pregnancy and/or labor and whose children did not receive these drugs, 10.4% of the mothers who had a cesarean transmitted the virus to their infants, compared to 19% of the mothers who had their babies using other forms of delivery.
Among mother-child pairs receiving antiretroviral therapy during the prenatal, intrapartum, and neonatal periods, rates of vertical transmission were 2.0% among the 196 mothers who underwent elective cesarean section and 7.3% among the 1,255 mothers with other modes of delivery.
Eligible studies were prospective cohort studies that included at least 100 mother-child pairs, that had data on the mode of delivery and the children’s infection status, and that were conducted in regions where HIV-1-infected women are advised not to breast-feed. Studies written in English were identified by computerized searches of the medical literature with the use of the Internet medical library Medline and through discussions with colleagues.
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