Increasing trend of cesarean deliveries in HIV-infected women in the United States from 1994 to 2000

Kenneth L. Dominguez, Mary Lou Lindegren, Philip J. D'Almada, Vicki B. Peters, Toni Frederick, Tamara A. Rakusan, Idith R. Ortiz, Ho Wen Hsu, Sharon K. Melville, Ramses F Sadek, Mary Glenn Fowler

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Meta-analysis and randomized clinical trial results reported in June 1998 indicated a significant reduction in perinatal HIV transmission rates among mothers undergoing a cesarean section (C-section). Objective: The objective of this study was to examine recent trends in and factors associated with C-section deliveries among HIV-infected women in the United States. Design: A multisite pediatric medical record review of a cohort of HIV-exposed and HIV-infected infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort study (n = 6467) and the national Pediatric HIV/AIDS Reporting System (HARS) (n= 8,306) was conducted. Setting/Patients: All infants born between 1994 and 2000 to HIV-positive mothers referred to the PSD study or to a Pediatric HARS hospital or clinic site were enrolled. Results: The proportion of deliveries by C-section was steady at about 20% from 1994 through June 1998. From July 1998 through December 2000, this proportion increased to 44% in the PSD study and to nearly 50% in the Pediatric HARS. On analysis by multiple logistic regression, delivery of infants by C-section was associated with the release of study results (OR = 2.83), delivery in four PSD sites in reference to Texas (OR: 2.02-1.43), having private medical care reimbursement (OR = 1.62), and having maternal prenatal care (OR = 1,43). Conclusions: The PSD and Pediatric HARS data demonstrate a sharp increase in C-section rates mainly among HIV-infected women in the United States after the release of the meta-analysis and randomized clinical trial results in 1998. This finding highlights the rapid impact of study results on obstetric practice. It underscores the critical role of prenatal care in offering perinatal interventions such as scheduled C-section when indicated to reduce the likelihood of HIV transmission.

Original languageEnglish (US)
Pages (from-to)232-238
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume33
Issue number2
DOIs
StatePublished - Jun 1 2003
Externally publishedYes

Fingerprint

HIV
Pediatrics
Cesarean Section
Acquired Immunodeficiency Syndrome
Prenatal Care
Mothers
Meta-Analysis
Randomized Controlled Trials
Information Systems
Obstetrics
Medical Records
Cohort Studies
Research Design
Logistic Models

Keywords

  • Cesarean section
  • Mode of delivery
  • Perinatal HIV transmission

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Dominguez, K. L., Lindegren, M. L., D'Almada, P. J., Peters, V. B., Frederick, T., Rakusan, T. A., ... Fowler, M. G. (2003). Increasing trend of cesarean deliveries in HIV-infected women in the United States from 1994 to 2000. Journal of Acquired Immune Deficiency Syndromes, 33(2), 232-238. https://doi.org/10.1097/00126334-200306010-00019

Increasing trend of cesarean deliveries in HIV-infected women in the United States from 1994 to 2000. / Dominguez, Kenneth L.; Lindegren, Mary Lou; D'Almada, Philip J.; Peters, Vicki B.; Frederick, Toni; Rakusan, Tamara A.; Ortiz, Idith R.; Hsu, Ho Wen; Melville, Sharon K.; Sadek, Ramses F; Fowler, Mary Glenn.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 33, No. 2, 01.06.2003, p. 232-238.

Research output: Contribution to journalArticle

Dominguez, KL, Lindegren, ML, D'Almada, PJ, Peters, VB, Frederick, T, Rakusan, TA, Ortiz, IR, Hsu, HW, Melville, SK, Sadek, RF & Fowler, MG 2003, 'Increasing trend of cesarean deliveries in HIV-infected women in the United States from 1994 to 2000', Journal of Acquired Immune Deficiency Syndromes, vol. 33, no. 2, pp. 232-238. https://doi.org/10.1097/00126334-200306010-00019
Dominguez, Kenneth L. ; Lindegren, Mary Lou ; D'Almada, Philip J. ; Peters, Vicki B. ; Frederick, Toni ; Rakusan, Tamara A. ; Ortiz, Idith R. ; Hsu, Ho Wen ; Melville, Sharon K. ; Sadek, Ramses F ; Fowler, Mary Glenn. / Increasing trend of cesarean deliveries in HIV-infected women in the United States from 1994 to 2000. In: Journal of Acquired Immune Deficiency Syndromes. 2003 ; Vol. 33, No. 2. pp. 232-238.
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abstract = "Background: Meta-analysis and randomized clinical trial results reported in June 1998 indicated a significant reduction in perinatal HIV transmission rates among mothers undergoing a cesarean section (C-section). Objective: The objective of this study was to examine recent trends in and factors associated with C-section deliveries among HIV-infected women in the United States. Design: A multisite pediatric medical record review of a cohort of HIV-exposed and HIV-infected infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort study (n = 6467) and the national Pediatric HIV/AIDS Reporting System (HARS) (n= 8,306) was conducted. Setting/Patients: All infants born between 1994 and 2000 to HIV-positive mothers referred to the PSD study or to a Pediatric HARS hospital or clinic site were enrolled. Results: The proportion of deliveries by C-section was steady at about 20{\%} from 1994 through June 1998. From July 1998 through December 2000, this proportion increased to 44{\%} in the PSD study and to nearly 50{\%} in the Pediatric HARS. On analysis by multiple logistic regression, delivery of infants by C-section was associated with the release of study results (OR = 2.83), delivery in four PSD sites in reference to Texas (OR: 2.02-1.43), having private medical care reimbursement (OR = 1.62), and having maternal prenatal care (OR = 1,43). Conclusions: The PSD and Pediatric HARS data demonstrate a sharp increase in C-section rates mainly among HIV-infected women in the United States after the release of the meta-analysis and randomized clinical trial results in 1998. This finding highlights the rapid impact of study results on obstetric practice. It underscores the critical role of prenatal care in offering perinatal interventions such as scheduled C-section when indicated to reduce the likelihood of HIV transmission.",
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AU - Peters, Vicki B.

AU - Frederick, Toni

AU - Rakusan, Tamara A.

AU - Ortiz, Idith R.

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AU - Sadek, Ramses F

AU - Fowler, Mary Glenn

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AB - Background: Meta-analysis and randomized clinical trial results reported in June 1998 indicated a significant reduction in perinatal HIV transmission rates among mothers undergoing a cesarean section (C-section). Objective: The objective of this study was to examine recent trends in and factors associated with C-section deliveries among HIV-infected women in the United States. Design: A multisite pediatric medical record review of a cohort of HIV-exposed and HIV-infected infants in the Pediatric Spectrum of HIV Disease (PSD) Cohort study (n = 6467) and the national Pediatric HIV/AIDS Reporting System (HARS) (n= 8,306) was conducted. Setting/Patients: All infants born between 1994 and 2000 to HIV-positive mothers referred to the PSD study or to a Pediatric HARS hospital or clinic site were enrolled. Results: The proportion of deliveries by C-section was steady at about 20% from 1994 through June 1998. From July 1998 through December 2000, this proportion increased to 44% in the PSD study and to nearly 50% in the Pediatric HARS. On analysis by multiple logistic regression, delivery of infants by C-section was associated with the release of study results (OR = 2.83), delivery in four PSD sites in reference to Texas (OR: 2.02-1.43), having private medical care reimbursement (OR = 1.62), and having maternal prenatal care (OR = 1,43). Conclusions: The PSD and Pediatric HARS data demonstrate a sharp increase in C-section rates mainly among HIV-infected women in the United States after the release of the meta-analysis and randomized clinical trial results in 1998. This finding highlights the rapid impact of study results on obstetric practice. It underscores the critical role of prenatal care in offering perinatal interventions such as scheduled C-section when indicated to reduce the likelihood of HIV transmission.

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