Increasing trend of Cesarean deliveries in HIV-infected women in the United States from 1994 to 2000.
BACKGROUND
Meta-analysis and randomized clinical trial results reported in June 1998 indicated a significant reduction in perinatal HIV transmission rates among mothers undergoing a cesarean section (C-section).


OBJECTIVE
The objective of this study was to examine recent trends in and factors associated with C-section deliveries among HIV-infected women in the United States.


METHODS
A multisite pediatric medical record review of a cohort of HIV-exposed and HIV-infected infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort study (n = 6467) and the national Pediatric HIV/AIDS Reporting System (HARS) (n = 8,306) was conducted.


METHODS
All infants born between 1994 and 2000 to HIV-positive mothers referred to the PSD study or to a Pediatric HARS hospital or clinic site were enrolled.


RESULTS
The proportion of deliveries by C-section was steady at about 20% from 1994 through June 1998. From July 1998 through December 2000, this proportion increased to 44% in the PSD study and to nearly 50% in the Pediatric HARS. On analysis by multiple logistic regression, delivery of infants by C-section was associated with the release of study results (OR = 2.83), delivery in four PSD sites in reference to Texas (OR: 2.02-1.43), having private medical care reimbursement (OR = 1.62), and having maternal prenatal care (OR = 1.43).


CONCLUSIONS
The PSD and Pediatric HARS data demonstrate a sharp increase in C-section rates mainly among HIV-infected women in the United States after the release of the meta-analysis and randomized clinical trial results in 1998. This finding highlights the rapid impact of study results on obstetric practice. It underscores the critical role of prenatal care in offering perinatal interventions such as scheduled C-section when indicated to reduce the likelihood of HIV transmission.
Dominguez
Kenneth L
KL
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, M-S E-45, Atlanta, GA 30333, USA. kld0@cdc.gov
Lindegren
Mary Lou
ML
D'Almada
Philip J
PJ
Peters
Vicki B
VB
Frederick
Toni
T
Rakusan
Tamara A
TA
Ortiz
Idith R
IR
Hsu
Ho-Wen
HW
Melville
Sharon K
SK
Sadek
Ramses
R
Fowler
Mary Glenn
MG
D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D016304:Hospitals, Private; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D016017:Odds Ratio; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000601:surgery*; D011295:Prenatal Care; D014481:United States