Vaginal delivery in women with HIV in Italy: results of 5 years of implementation of the national SIGO-HIV protocol

for SIGO-HIV Study Group

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the maternal and neonatal safety of vaginal delivery in women with HIV following the implementation of a national protocol in Italy. Methods: Vaginal delivery was offered to all eligible women who presented antenatally at twelve participating clinical sites. Data collection and definition of outcomes followed the procedures of the National Program on Surveillance on Antiretroviral Treatment in Pregnancy. Pregnancy outcomes were compared according to the mode of delivery, classified as vaginal, elective cesarean (ECS) and non-elective cesarean section (NECS). Results: Among 580 women who delivered between January 2012 and September 2017, 142 (24.5%) had a vaginal delivery, 323 (55.7%) had an ECS and 115 (19.8%) had an NECS. The proportion of vaginal deliveries increased significantly over time, from 18.9% in 2012 to 35.3% in 2017 (p < 0.001). Women who delivered vaginally were younger, more commonly nulliparous, diagnosed with HIV during current pregnancy, and antiretroviral-naïve, but had a slightly longer duration of pregnancy, with significantly higher birthweight of newborns. NECS was associated with adverse pregnancy outcomes. The rate of HIV transmission was minimal (0.4%). There were no differences between vaginal and ECS about delivery complications, while NECS was more commonly associated with complications compared to ECS. Conclusions: Vaginal delivery in HIV-infected women with suppressed viral load appears to be safe for mother and children. No cases of HIV transmission were observed. Despite an ongoing significant increase, the rate of vaginal delivery remains relatively low compared to other countries, and further progress is needed to promote this mode of delivery in clinical practice.

Original languageEnglish
JournalInfection
DOIs
Publication statusPublished - Jan 1 2019

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Italy
Cesarean Section
HIV
Pregnancy Outcome
Pregnancy
Mothers
Viral Load
Newborn Infant
Safety
Therapeutics

Keywords

  • Delivery complications
  • HIV
  • Mode of delivery
  • Pregnancy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Vaginal delivery in women with HIV in Italy : results of 5 years of implementation of the national SIGO-HIV protocol. / for SIGO-HIV Study Group.

In: Infection, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Vaginal delivery in women with HIV in Italy: results of 5 years of implementation of the national SIGO-HIV protocol",
abstract = "Purpose: To evaluate the maternal and neonatal safety of vaginal delivery in women with HIV following the implementation of a national protocol in Italy. Methods: Vaginal delivery was offered to all eligible women who presented antenatally at twelve participating clinical sites. Data collection and definition of outcomes followed the procedures of the National Program on Surveillance on Antiretroviral Treatment in Pregnancy. Pregnancy outcomes were compared according to the mode of delivery, classified as vaginal, elective cesarean (ECS) and non-elective cesarean section (NECS). Results: Among 580 women who delivered between January 2012 and September 2017, 142 (24.5{\%}) had a vaginal delivery, 323 (55.7{\%}) had an ECS and 115 (19.8{\%}) had an NECS. The proportion of vaginal deliveries increased significantly over time, from 18.9{\%} in 2012 to 35.3{\%} in 2017 (p < 0.001). Women who delivered vaginally were younger, more commonly nulliparous, diagnosed with HIV during current pregnancy, and antiretroviral-na{\"i}ve, but had a slightly longer duration of pregnancy, with significantly higher birthweight of newborns. NECS was associated with adverse pregnancy outcomes. The rate of HIV transmission was minimal (0.4{\%}). There were no differences between vaginal and ECS about delivery complications, while NECS was more commonly associated with complications compared to ECS. Conclusions: Vaginal delivery in HIV-infected women with suppressed viral load appears to be safe for mother and children. No cases of HIV transmission were observed. Despite an ongoing significant increase, the rate of vaginal delivery remains relatively low compared to other countries, and further progress is needed to promote this mode of delivery in clinical practice.",
keywords = "Delivery complications, HIV, Mode of delivery, Pregnancy",
author = "{for SIGO-HIV Study Group} and Cecilia Tibaldi and G. Masuelli and Matilde Sansone and B. Tassis and Irene Cetin and Laura Franceschetti and A. Spinillo and Giuliana Simonazzi and Antonella Vimercati and Serena Dalzero and Alessandra Meloni and Maria Bernardon and Valentina Frisina and Cosimo Polizzi and Tullia Todros and Pasquale Martinelli and Marco Floridia and Marina Ravizza and C. Tibaldi and T. Todros and G. Masuelli and V. Frisina and L. Trentini and B. Tassis and G. Tiso and I. Cetin and T. Brambilla and V. Savasi and C. Personeni and G. Zuccotti and V. Giacomet and S. Coletto and {Di Nello}, F. and C. Madia and L. Franceschetti and Forleo, {M. A.} and R. Badolato and A. Spinillo and M. Roccio and D. Zanaboni and M. Sansone and P. Martinelli and A. Sirico and Maruotti, {G. M.} and A. Capone and G. Simonazzi and B. Guerra and F. Cervi and G. Maso and S. Alberico",
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month = "1",
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journal = "Infection",
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T1 - Vaginal delivery in women with HIV in Italy

T2 - results of 5 years of implementation of the national SIGO-HIV protocol

AU - for SIGO-HIV Study Group

AU - Tibaldi, Cecilia

AU - Masuelli, G.

AU - Sansone, Matilde

AU - Tassis, B.

AU - Cetin, Irene

AU - Franceschetti, Laura

AU - Spinillo, A.

AU - Simonazzi, Giuliana

AU - Vimercati, Antonella

AU - Dalzero, Serena

AU - Meloni, Alessandra

AU - Bernardon, Maria

AU - Frisina, Valentina

AU - Polizzi, Cosimo

AU - Todros, Tullia

AU - Martinelli, Pasquale

AU - Floridia, Marco

AU - Ravizza, Marina

AU - Tibaldi, C.

AU - Todros, T.

AU - Masuelli, G.

AU - Frisina, V.

AU - Trentini, L.

AU - Tassis, B.

AU - Tiso, G.

AU - Cetin, I.

AU - Brambilla, T.

AU - Savasi, V.

AU - Personeni, C.

AU - Zuccotti, G.

AU - Giacomet, V.

AU - Coletto, S.

AU - Di Nello, F.

AU - Madia, C.

AU - Franceschetti, L.

AU - Forleo, M. A.

AU - Badolato, R.

AU - Spinillo, A.

AU - Roccio, M.

AU - Zanaboni, D.

AU - Sansone, M.

AU - Martinelli, P.

AU - Sirico, A.

AU - Maruotti, G. M.

AU - Capone, A.

AU - Simonazzi, G.

AU - Guerra, B.

AU - Cervi, F.

AU - Maso, G.

AU - Alberico, S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To evaluate the maternal and neonatal safety of vaginal delivery in women with HIV following the implementation of a national protocol in Italy. Methods: Vaginal delivery was offered to all eligible women who presented antenatally at twelve participating clinical sites. Data collection and definition of outcomes followed the procedures of the National Program on Surveillance on Antiretroviral Treatment in Pregnancy. Pregnancy outcomes were compared according to the mode of delivery, classified as vaginal, elective cesarean (ECS) and non-elective cesarean section (NECS). Results: Among 580 women who delivered between January 2012 and September 2017, 142 (24.5%) had a vaginal delivery, 323 (55.7%) had an ECS and 115 (19.8%) had an NECS. The proportion of vaginal deliveries increased significantly over time, from 18.9% in 2012 to 35.3% in 2017 (p < 0.001). Women who delivered vaginally were younger, more commonly nulliparous, diagnosed with HIV during current pregnancy, and antiretroviral-naïve, but had a slightly longer duration of pregnancy, with significantly higher birthweight of newborns. NECS was associated with adverse pregnancy outcomes. The rate of HIV transmission was minimal (0.4%). There were no differences between vaginal and ECS about delivery complications, while NECS was more commonly associated with complications compared to ECS. Conclusions: Vaginal delivery in HIV-infected women with suppressed viral load appears to be safe for mother and children. No cases of HIV transmission were observed. Despite an ongoing significant increase, the rate of vaginal delivery remains relatively low compared to other countries, and further progress is needed to promote this mode of delivery in clinical practice.

AB - Purpose: To evaluate the maternal and neonatal safety of vaginal delivery in women with HIV following the implementation of a national protocol in Italy. Methods: Vaginal delivery was offered to all eligible women who presented antenatally at twelve participating clinical sites. Data collection and definition of outcomes followed the procedures of the National Program on Surveillance on Antiretroviral Treatment in Pregnancy. Pregnancy outcomes were compared according to the mode of delivery, classified as vaginal, elective cesarean (ECS) and non-elective cesarean section (NECS). Results: Among 580 women who delivered between January 2012 and September 2017, 142 (24.5%) had a vaginal delivery, 323 (55.7%) had an ECS and 115 (19.8%) had an NECS. The proportion of vaginal deliveries increased significantly over time, from 18.9% in 2012 to 35.3% in 2017 (p < 0.001). Women who delivered vaginally were younger, more commonly nulliparous, diagnosed with HIV during current pregnancy, and antiretroviral-naïve, but had a slightly longer duration of pregnancy, with significantly higher birthweight of newborns. NECS was associated with adverse pregnancy outcomes. The rate of HIV transmission was minimal (0.4%). There were no differences between vaginal and ECS about delivery complications, while NECS was more commonly associated with complications compared to ECS. Conclusions: Vaginal delivery in HIV-infected women with suppressed viral load appears to be safe for mother and children. No cases of HIV transmission were observed. Despite an ongoing significant increase, the rate of vaginal delivery remains relatively low compared to other countries, and further progress is needed to promote this mode of delivery in clinical practice.

KW - Delivery complications

KW - HIV

KW - Mode of delivery

KW - Pregnancy

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U2 - 10.1007/s15010-019-01336-z

DO - 10.1007/s15010-019-01336-z

M3 - Article

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JO - Infection

JF - Infection

SN - 0300-8126

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