Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
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United Press International; Friday June 26 7:25 PM EDT
Lori Valigra in Cambridge, Mass
The study _ the largest and most comprehensive of its kind _ analyzed 8,533 mother and child pairs from five European and 10 North American studies over a 12-year period until 1996. It was led by the National Institute of Child Health and Human Development (NICHD) in Bethesda, Md.
HIV is most likely to be transmitted to a baby during labor and delivery, said Dr. Bob Nugent, associate chief of epidemiologic and biostatistical research at NICHD's Pediatric, Adolescent and Maternal AIDS branch.
"The virus is in the vaginal secretions of women," Nugent said. "Once the vaginal walls rupture during labor and delivery, the infant can become exposed to the virus."
That rupturing is kept to a minimum during an elective c-section. An elective c-section takes place before labor begins, and thus before membranes rupture. While the baby could be exposed to the mother's blood for 1-5 minutes, that is still shorter than other delivery methods.
Some 7,000 American women with HIV give birth each year, Nugent said. Before 1994, when antiretroviral AZT therapy became available to successfully combat the transmission risk, some 20-25 percent of babies got HIV from their mothers. AZT given to the mother during pregnancy, labor and delivery and then to the child during the first six weeks of life reduced that transmission rate by two-thirds, according to Nugent.
The mothers who took part in the new study were divided into four groups: 1) those who had elective c-sections, 2) those who had a c- section after rupture of membranes and/or labor began, 3) those who delivered vaginally with assistance from forceps or vacuum suction, and 4) those who delivered vaginally with neither forceps nor vacuum suction.
The analysis compared the likelihood of HIV infection among the 857 children whose mothers delivered by elective c-section to that of the 7, 676 whose mothers delivered by other methods. The former group were 50 percent less likely to get HIV from their mothers.
Of the 5,944 mothers who did not receive AZT or other antiretroviral drug regimens, 10.4 percent of those who delivered by elective c-section transmitted the virus to their infants. That compares with 19 percent of the women who delivered by other methods.
Of the 1,451 mothers who received an antiretroviral drug regimen, only 2 percent who delivered by elective c-section transmitted the virus to their children, compared to 7.3 percent of those who delivered by other means.
While the research shows that HIV-infected women do decrease the likelihood of infecting their children with elective c-sections, Nugent said the risk to the child must be weighed against the risk to the mother. C-sections may cause mothers to get other infections.
"We still haven't taken the data to a point where we recommend that all women get a c-section," Nugent said. "HIV-infected women need to talk to their doctor about our study and look at the risks and benefits of a c-section." The results will be presented June 30 at the 12th International Conference on AIDS in Geneva, Switzerland.
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