Mode of delivery and gestational age influence perinatal HIV-1 transmission

Pier Angelo Tovo, Maurizio De Martino, Clara Gabiano, Luisa Galli, Nazario Cappello, Ezia Ruga, Silvia Tulisso, Alberto Vierucci, Anna Loy, Gian Vincenzo Zuccotti, Anna Maria Bucceri, Anna Plebani, Paola Marchisio, Desireé Caselli, Susanna Liviadotti, Paola Dallacasa, Carlo Fundaró, Michele Stegagno, Carmine Timpano, Maurizio RuggeriMarzia Duse, Mariella Belloni, Pietro Cocchi, Stefania Risso, Gian Luca Forni, Rita Lipreri, Filippo Ciccimarra, Rita Consolini, Giorgio Benaglia, Giuseppe Caramia, Ugo De Santis, Rer Giorgio Chiriacó, Carlo Dessí, Paola Ibba, Libero Zannino, Felicia Di Gregorio, Antonella Sciotto, Maria Teresa Cecchi, Elio Boeri, Anna Meo, Luigi Angelo Magni, Roberto Altobelli, Iginio Contardi, Giorgio Gambaretto, Luigi Esposito, Gianni Bona, Sergio Giordano, Imelde Ragazzini, Cristiana Magnani, Silvano Bionda, Antonio Pellegatta

Research output: Contribution to journalArticlepeer-review


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, breastfeeding (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 (≤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.

Original languageEnglish
Pages (from-to)88-94
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology
Issue number1
Publication statusPublished - 1996


  • Breast- feeding
  • Cesarean delivery
  • Length of pregnancy
  • Mother's clinical condition
  • Perinatal HIV-1 transmission rate

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Virology


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