title: Mode of delivery and infant respiratory morbidity among infants born to HIV-1-infected women.
abstract: OBJECTIVE
  To estimate risk of infant respiratory morbidity associated with cesarean delivery before labor and ruptured membranes among HIV-1-infected women.
  
  
  METHODS
  In a prospective cohort study of HIV-1-infected women and their infants, mode of delivery was determined by clinicians at the participating sites. For this analysis, "elective cesarean delivery" was defined as any cesarean delivery, regardless of gestational age, without labor and with duration of ruptured membranes of less than 5 minutes. Nonelective cesarean deliveries were those performed after the onset of labor, rupture of membranes, or both. Vaginal delivery included normal spontaneous and instrument deliveries. Associations between mode of delivery and infant respiratory morbidity were assessed using chi or Fisher's exact test. Adjusted odds of respiratory distress syndrome by delivery mode were assessed using multivariable logistic regression.
  
  
  RESULTS
  Among 1,194 mother-infant pairs, there were significant differences according to mode of delivery in median gestational age (weeks) at delivery (vaginal, n=566, median=38.8; nonelective cesarean, n=216, median=38.0; and elective cesarean, n=412, median 38.1; P<.001) and incidence of respiratory distress syndrome (vaginal, n=9, 1.6%, reference; nonelective cesarean, n=16, 7.4%; elective cesarean, n=18; 4.4%; (P<.001). In analyses adjusted for gestational age and birth weight, mode of delivery was not statistically significantly associated with infant respiratory distress syndrome (P=.10), although a trend toward an increased risk of respiratory distress syndrome among infants delivered by cesarean was suggested (nonelective cesarean adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 0.95-5.67; elective cesarean OR 2.56, 95% CI 1.01-6.48).
  
  
  CONCLUSIONS
  Respiratory distress syndrome rates associated with elective cesarean delivery among HIV-1-infected women are low, comparable with published rates among uninfected women. There is minimal neonatal respiratory morbidity risk in near-term infants born by elective cesarean delivery to HIV-1-infected women.
  
  
  METHODS
  II.
authors.affiliation: From Duke University, Durham, North Carolina; Harvard School of Public Health, Center for Biostatistics in Acquired Immunodeficiency Syndrome (AIDS) Research, Boston, Massachusetts; Harvard University, Boston, Massachusetts; the University of Miami Miller School of Medicine, Miami, Florida; the University of Medicine and Dentistry of New Jersey, Newark, New Jersey; the University of Southern California, Los Angeles, California; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Livingston
authors.forename: Yanling
authors.initials: Y
authors.lastname: Huo
authors.forename: Kunjal
authors.initials: K
authors.lastname: Patel
authors.forename: Susan B
authors.initials: SB
authors.lastname: Brogly
authors.forename: Ruth
authors.initials: R
authors.lastname: Tuomala
authors.forename: Gwendolyn B
authors.initials: GB
authors.lastname: Scott
authors.forename: Arlene
authors.initials: A
authors.lastname: Bardeguez
authors.forename: Alice
authors.initials: A
authors.lastname: Stek
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D055815:Young Adult