HIV Med. 2010 Jul 1;11(6):368-78. doi: 10.1111/j.1468-1293.2009.00800.x. Epub 2010 Jan 4.
The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations between mode of delivery and mother-to-child transmission (MTCT).
The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their infants prospectively followed. Data on 5238 mother-child pairs (MCPs) enrolled in Western European ECS sites between 1985 and 2007 were analysed.
The elective CS rate increased from 16% in 1985-1993 to 67% in 1999-2001, declining to 51% by 2005-2007. In 2002-2004, 10% of infants were delivered vaginally, increasing to 34% by 2005-2007. During the HAART era, women in Belgium, the United Kingdom and the Netherlands were less likely to deliver by elective CS than those in Italy and Spain [adjusted odds ratio (AOR) 0.07; 95% confidence interval (CI) 0.04-0.12]. The MTCT rate in 2005-2007 was 1%. Among MCPs with maternal HIV RNA<400 HIV-1 RNA copies/mL (n=960), elective CS was associated with 80% decreased MTCT risk (AOR 0.20; 95% CI 0.05-0.65) adjusting for HAART and prematurity. Two infants born to 559 women with viral loads <50 copies/mL were infected, one of whom was delivered by elective CS (MTCT rate 0.4%; 95% CI 0.04-1.29).
Our findings suggest that elective CS prevents MTCT even at low maternal viral loads, but the study was insufficiently powered to enable a conclusion to be drawn as to whether this applies for viral loads <50 copies/mL. Diverging mode of delivery patterns in Europe reflect uncertainties regarding the risk-benefit balance of elective CS for women on successful HAART.
本研究旨在分析在欧洲合作研究（ECS）中分娩方式的时间和地域模式，确定高效抗逆转录病毒治疗（HAART）时代与选择性剖宫产（CS）分娩相关的因素，并探讨分娩方式与母婴传播（MTCT）之间的关联。
ECS 是一项队列研究，对入组的 HIV 感染孕妇及其婴儿进行前瞻性随访。对 1985 年至 2007 年期间在西欧 ECS 站点入组的 5238 对母婴对（MCP）的数据进行了分析。
1985 年至 1993 年期间，选择性 CS 率从 16%上升至 1999 年至 2001 年的 67%，至 2005 年至 2007 年下降至 51%。2002 年至 2004 年，10%的婴儿经阴道分娩，至 2005 年至 2007 年增至 34%。在 HAART 时代，比利时、英国和荷兰的妇女选择行 CS 分娩的可能性低于意大利和西班牙的妇女[调整后的优势比（AOR）0.07；95%置信区间（CI）0.04-0.12]。2005 年至 2007 年期间的 MTCT 率为 1%。在母婴 HIV RNA<400 HIV-1 RNA 拷贝/mL（n=960）的 MCP 中，选择性 CS 与 MTCT 风险降低 80%相关（AOR 0.20；95%CI 0.05-0.65），校正 HAART 和早产因素后。559 名病毒载量<50 拷贝/mL 的妇女所生的 2 名婴儿感染，其中 1 名经选择性 CS 分娩（MTCT 率为 0.4%；95%CI 0.04-1.29）。
我们的研究结果表明，即使在母亲病毒载量较低的情况下，选择性 CS 也可以预防 MTCT，但本研究的效力不足，无法得出对于病毒载量<50 拷贝/mL 的情况下是否适用的结论。欧洲不同的分娩方式模式反映了在成功接受 HAART 的妇女中，选择性 CS 的风险效益平衡方面存在不确定性。
