United Press International - November 12, 2005
Lidia Wasowicz, Senior Science Writer

A review of studies shows delivery by a preplanned Caesarian section can avert the mother-to-child transmission of the AIDS virus, HIV, in some cases.

The possibility of infection and other potential hazards of an elective C-section to HIV-positive women who are not using antiretroviral medication and who have no other medical condition is outweighed by the benefits of reduced risk of passing the virus on to the newborn, scientists found.

Dr. Jennifer Read of the Pediatric, Adolescent and Maternal AIDS Branch at the National Institute of Child Health and Human Development says few previous studies have looked into the effectiveness or safety of planning C-section deliveries as a preventive measure in such cases.

The review, published in The Cochrane Library, examined numerous studies, including one of 408 HIV-positive pregnant women, conducted by the European Mode of Delivery Collaboration. The women, who were not on antiretroviral treatment or were taking only zidovudine, or AZT, either had a C-section or gave birth vaginally.

The virus was transmitted to the baby in 3.5 percent of the C-section births, compared to 10.2 percent of the vaginal ones.

Most HIV-positive pregnant women in developed countries take several antiretroviral drugs before and during birth, greatly reducing the incidence of mothers infecting their babies, Read notes.

However, the study says, such transmission is the most common cause of the infection in children worldwide, affecting more than 2,000 babies each day. An estimated half million children died of AIDS in 2004, making reduction of the risk of maternal HIV transmission a major global public health goal.

As a preventive measure, the Caesarian must be planned to take place before the start of labor and the rupture of membranes, the authors explain.

Although medications have lowered the risk a mother will infect her baby during the birth process, she can still transmit the virus through her breast milk, researchers say.

Breast milk, if doled out too liberally, also can potentially raise the risk of cavities in children whose teeth have erupted, other research shows.

Investigators at the University of Rochester in New York have found milk from mom -- though far less likely to rot teeth than colas or drinks seeped in sucrose or honey -- is worse on a tot's dental health than milk from a cow.

In their study, published in Pediatrics, Ruth Lawrence, an authority on breastfeeding, and William Bowen, an expert on tooth decay, warn against letting babies drink sugary liquids, sweetening water with honey, a practice wrongly promoted as dentally sound, or permitting infants to fall asleep while nursing. The authors stress breast milk has superior health benefits over cow's milk for a growing infant but call attention to the need for oral hygiene after feedings, especially when the infant's teeth have started to emerge.

"Obviously, cola and other sugary drinks and honey are highly cavity promoting and erosive to teeth, and should be actively discouraged in children," Bowen says. "Early caries is costly to treat and may carry additional burdens on the health of children, yet despite greater awareness, it continues to plague a significant part of the population."

Lawrence advises moms against allowing their babies to pull all-nighters at the nipple once teeth have made their appearance.

Other researchers warn against another popular but dangerous nighttime practice: letting baby sleep in the parents' bed. Rather, infants should slumber in their own crib, revised guidelines of the American Academy of Pediatrics advise, reiterating a position first stated in 2000.

"The recommendation five years ago said that in some circumstances, allowing a baby to sleep in an adult bed can be dangerous," says Dr. James Kemp, associate professor of pediatrics at Saint Louis University and director of the Sleep Disorder Program at SSM Cardinal Glennon Children's Hospital. "This one said you shouldn't do it."

Kemp's research shows infants who spend the night in an adult bed face a risk of suffocation up to 40 times that of babies who snooze in standard cribs.

Bed-sharing advocates tout the practice as promoting breastfeeding and closeness.

In their new advisory, pediatricians recommend babies sleep in a safe crib, bassinet or cradle in the parents' bedroom.

"Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep," the statement says.

The policy reiterates infants should be placed on their backs -- not on their stomachs or sides -- to sleep. Babies should slumber on a firm crib mattress, covered by a sheet, with no soft, cushy bedding such as pillows, comforters or quilts, in a room that isn't overly hot.

Doctors also warn moms-to-be against smoking, an unhealthy habit that increases a baby's risk of sudden infant death syndrome.

The experts issue an alarm of what can bring the young to harm: How they're born and what they eat and even where they're put to sleep.
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