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 language | English |
|---|---|
| Journal | Infection |
| DOIs | |
| Publication status | Published - Jan 1 2019 |
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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 journal › Article
}
TY - JOUR
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
UR - http://www.scopus.com/inward/record.url?scp=85068877602&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068877602&partnerID=8YFLogxK
U2 - 10.1007/s15010-019-01336-z
DO - 10.1007/s15010-019-01336-z
M3 - Article
AN - SCOPUS:85068877602
JO - Infection
JF - Infection
SN - 0300-8126
ER -