title: Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study.
abstract: OBJECTIVE
  To investigate the association between duration of rupture of membranes (ROM) and mother-to-child HIV transmission (MTCT) rates in the era of combination antiretroviral therapy (cART).
  
  
  METHODS
  The National Study of HIV in Pregnancy and Childhood (NSHPC) undertakes comprehensive population-based surveillance of HIV in pregnant women and children.
  
  
  METHODS
  UK and Ireland.
  
  
  METHODS
  A cohort of 2398 singleton pregnancies delivered vaginally, or by emergency caesarean section, in women on cART in pregnancy during the period 2007-2012 with information on duration of ROM; HIV infection status was available for 1898 infants.
  
  
  METHODS
  Descriptive analysis of NSHPC data.
  
  
  METHODS
  Rates of MTCT.
  
  
  RESULTS
  In 2116 pregnancies delivered at term, the median duration of ROM was 3 hours 30 minutes (interquartile range, IQR 1-8 hours). The overall MTCT rate for women delivering at term with duration of ROM ≥4 hours was 0.64% compared with 0.34% for ROM <4 hours, with no significant difference between the groups (OR 1.90, 95% CI 0.45-7.97). In women delivering at term with a viral load of <50 copies/ml, there was no evidence of a difference in MTCT rates with duration of ROM ≥4 hours, compared with <4 hours (0.14% for ≥4 hours versus 0.12% for <4 hour; OR 1.14, 95% CI 0.07-18.27). Among infants born preterm with infection status available, there were no transmissions in 163 deliveries where the maternal viral load was <50 copies/ml.
  
  
  CONCLUSIONS
  No association was found between duration of ROM and MTCT in women taking cART.
  
  
  CONCLUSIONS
  Rupture of membranes of more than 4 hours is not associated with MTCT of HIV in women on effective ART delivering at term.
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Peters
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Byrne
authors.affiliation: Guys & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: De Ruiter
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Francis
authors.affiliation: Guys & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Harding
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: G P
authors.initials: GP
authors.lastname: Taylor
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Tookey
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Townsend
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005321:Extraembryonic Membranes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007743:Labor, Obstetric; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D047928:Premature Birth; D047929:Term Birth; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Duration of ruptured membranes; HIV; mother-to-child transmission; pregnancy