Tovo P A, de Martino M, Gabiano C, Galli L, Cappello N, Ruga E, Tulisso S, Vierucci A, Loy A, Zuccotti G V
Department of Pediatrics, University of Turin, Italy.
J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jan 1;11(1):88-94. doi: 10.1097/00042560-199601010-00012.
Some data suggest that cesarean section reduces mother-to-child HIV-1 transmission. To assess the influence of mode of delivery and other maternal and infant factors on the rate of transmission, we analyzed the data of 1,624 children prospectively followed from birth. Of these, at the last visit 1,033 were > 18 months of age or would have been had they not died of HIV-related illness. Among the 975 first singleton children, 180 [18.5%; 95% confidence limits (CL), 16.1-20.9] acquired infection, as did 8 of 56 (14.3%; 95% CL, 5.1-23.5) second-born children. Multivariate stepwise analysis showed that vaginal delivery and development of symptoms in the mother were significantly and independently associated with a higher transmission rate (vaginal delivery; odds ratio, 1.69; 95% CL, 1.14-2.5; symptoms: odds ratio, 1.61; 95% CL, 1.12-2.3). In contrast, a history of maternal drug use, birth weight, breast-feeding (only 37 infants were breast-fed), and child's sex did not have a significant impact on viral transmission. The percentage of infected children was highest (30.7%) among very premature infants (< or = 32 weeks of gestation); this significant trend subsequently decreased to 11.9% at the week 42 (p < 0.001), suggesting a parallel reduction in peripartum transmission. The reduced rate of infection observed in infants born by cesarean section underlines the urgent need for randomized controlled trials to evaluate the protective role of surgical delivery in preventing perinatal HIV-1 transmission.
一些数据表明，剖宫产可降低母婴间HIV-1传播率。为评估分娩方式及其他母婴因素对传播率的影响，我们分析了1624名儿童自出生起接受前瞻性随访的数据。其中，在最后一次随访时，1033名儿童年龄超过18个月，若未死于HIV相关疾病本应超过18个月。在975名头胎单胎儿童中，180名（18.5%；95%置信区间[CL]，16.1 - 20.9）感染了HIV，56名二胎儿童中有8名（14.3%；95% CL，5.1 - 23.5）感染。多因素逐步分析显示，阴道分娩及母亲出现症状与较高的传播率显著且独立相关（阴道分娩；优势比，1.69；95% CL，1.14 - 2.5；症状：优势比，1.61；95% CL，1.12 - 2.3）。相比之下，母亲吸毒史、出生体重、母乳喂养（仅37名婴儿接受母乳喂养）及儿童性别对病毒传播无显著影响。在极早产儿（孕周≤32周）中，感染儿童的比例最高（30.7%）；这一显著趋势随后在42周时降至11.9%（p < 0.001），提示围产期传播率也相应降低。剖宫产出生婴儿感染率降低凸显了开展随机对照试验以评估手术分娩在预防围产期HIV-1传播中保护作用的迫切需求。
