Newell M L, Dunn D T, Peckham C S, Semprini A E, Pardi G
Department of Epidemiology, Institute of Child Health, London, UK.
AIDS. 1996 Dec;10(14):1675-81.
To estimate the effect of maternal factors and events around the time of delivery on HIV-1 vertical transmission risk.
Prospective study.
Twenty-two obstetric and paediatric clinics in seven European countries.
Mothers identified as HIV-infected before or at delivery and their children.
Paediatric HIV infection.
By November 1995, 1846 mothers with 1945 children had been enrolled. The vertical transmission rate was 16.4% (95% confidence interval, 14.5-18.3). Parity, maternal age, race, mode of HIV acquisition, injecting drug use and sex of infant were not statistically significantly associated with risk of transmission. Children delivered vaginally were more likely to be infected than those delivered by Caesarean section. However, in vaginal deliveries the procedures used, duration of ruptured membranes or length of second-stage labour were not related to transmission. Transmission increased almost linearly with decreasing CD4 cell count, but there was no such trend for CD8 cell count. Women with CD4 cell counts below 200 x 10(6)/l were significantly more likely to deliver early (chi 2 for trend, 14.02; P < 0.001). Very premature infants were at increased risk of infection, but after about 35 weeks gestation the transmission rate remained stable, with no increase in late pregnancy. This trend was confirmed after allowing for maternal CD4 cell count.
The rate of vertical transmission increases linearly with decreasing maternal CD4 cell count. Women with fewer than 200 x 10(6) CD4 cells/l have an increased risk of premature delivery, which would affect timing of interventions. The stable transmission rate after 35 weeks gestation suggests little acquisition of infection during late pregnancy.
评估分娩前后孕产妇因素及事件对HIV-1垂直传播风险的影响。
前瞻性研究。
欧洲七个国家的22家产科和儿科诊所。
在分娩前或分娩时被确定为感染HIV的母亲及其子女。
儿童HIV感染情况。
至1995年11月，共纳入1846名母亲及其1945名子女。垂直传播率为16.4%（95%置信区间为14.5 - 18.3）。产次、孕产妇年龄、种族、感染HIV的途径、注射吸毒情况及婴儿性别与传播风险无统计学显著关联。经阴道分娩的儿童比剖宫产分娩的儿童更易感染。然而，在阴道分娩中，所采用的操作、胎膜破裂时间或第二产程时长与传播无关。传播风险几乎随CD4细胞计数的降低呈线性增加，但CD8细胞计数无此趋势。CD4细胞计数低于200×10⁶/l的女性早产的可能性显著更高（趋势检验χ² = 14.02；P < 0.001）。极早产儿感染风险增加，但妊娠约35周后传播率保持稳定，妊娠晚期无增加。在考虑孕产妇CD4细胞计数后，这一趋势得到证实。
垂直传播率随孕产妇CD4细胞计数的降低呈线性增加。CD4细胞计数低于200×10⁶/l的女性早产风险增加，这会影响干预时机。妊娠35周后传播率稳定，提示妊娠晚期感染几率较低。
