title: Maternal CD4+ microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section.
abstract: Maternal CD4+ cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns.
  
  
  
  To evaluate maternal CD4+ cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section.
  
  
  
  In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4+ cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery.
  
  
  
  Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4+ cells (95% confidence interval (CI): 0.00-0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01-0.66% maternal cells (95% CI: -0.06-0.16; P=0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4+ cells in one (0.05%; 95% CI: -0.02-0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: -0.06-0.16; P=0.04). There was no MTCT in any of the newborns.
  
  
  
  In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4+ cell transfer to newborns compared to planned caesarean section.
authors.affiliation: Goethe University, Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt/Main, Germany. Electronic address: horst.buxmann@kgu.de.
authors.forename: H
authors.initials: H
authors.lastname: Buxmann
authors.affiliation: Department of Gynecology and Obstetrics, Division of Obstetrics and Prenatal Medicine, University Hospital Frankfurt/Main, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Reitter
authors.affiliation: Goethe University, Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt/Main, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Bapistella
authors.affiliation: Institute for Medical Virology, University Hospital Frankfurt/Main, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stürmer
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Königs
authors.affiliation: Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt/Main, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Ackermann
authors.affiliation: Department of Gynecology and Obstetrics, Division of Obstetrics and Prenatal Medicine, University Hospital Frankfurt/Main, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Louwen
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bader
authors.affiliation: Goethe University, Department for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt/Main, Germany.
authors.forename: R L
authors.initials: RL
authors.lastname: Schlößer
authors.affiliation: Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Germany.
authors.forename: A M
authors.initials: AM
authors.lastname: Willasch
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000821:virology*; D002585:Cesarean Section / Q000009:adverse effects*; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood*
chemical_list: D004279:DNA, Viral
keywords: CD4+ cell microchimerism; HIV; Mode of delivery; Mother-to-child transmission; Newborn