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Increasing Trend of Cesarean Deliveries in HIV-Infected Women in the United States From 1994 to 2000

Dominguez Kenneth L.; Lindegren, Mary Lou; d'Almada, Philip J.; Peters, Vicki B.; Frederick, Toni; Rakusan, Tamara A.; Ortiz, Idith R.; Hsu, Ho-Wen; Melville, Sharon K.; Sadek, Ramses; Fowler, Mary Glenn; for the Pediatric Spectrum of HIV Disease Consortium
JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2003

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.

Design: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.

Setting/Patients: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.

Address correspondence and reprint requests to Kenneth L. Dominguez, Centers for Disease Control and Prevention, 1600 Clifton Road, M-S E-45, Atlanta, GA, U.S.A. 30333. E-mail:

Manuscript received September 4, 2002; accepted February 20, 2003.

© 2003 Lippincott Williams & Wilkins, Inc.