Acquiring Human Immunodeficiency Virus During Pregnancy and Mother-to-Child Transmission in New York 2002-2006

OBJECTIVE: To assess perinatal human immunodeficiency virus (HIV) exposure and factors associated with mother-to-child HIV transmission. METHODS: A cohort analysis of HIV-exposed births in New York State from 2002 to 2006 was undertaken using routinely collected public health surveillance and regulatory data, including Newborn Screening HIV antibody results, pediatric HIV diagnostic test results, and maternal and pediatric medical record abstractions. RESULTS: Between January 2002 and December 2006, we identified 3,396 HIV-exposed neonoates. Subsequent analysis of 3,102 (91%) birth events showed that mother-to-child HIV transmission was presumed or confirmed to have occurred in 65 neonates (2.1%) born to 63 mothers. On multivariable analysis, the following significant associations with transmission were identified: maternal HIV diagnosis at or after delivery (odds ratio [OR] 3.24, 95% [CI] 1.15-8.15), maternal acquisition of HIV during pregnancy (OR 15.19, 95% CI 3.98-56.30), illicit substance use during pregnancy (OR 2.66, 95% CI 1.33-5.27), 0-2 prenatal care visits (OR 2.37, 95% CI 1.11-4.91), and neonatal birth weight less than 2,500 g (OR 2.46, 95% CI 1.26-4.74). CONCLUSION: Acquisition of HIV during pregnancy is a significant risk factor for mother-to-child HIV transmission and must be addressed along with other known risks to reduce mother-to-child transmission to the greatest extent possible. (Obstet Gynecol 2010; 115: 1247-55)