Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study.
OBJECTIVE
To investigate the association between duration of rupture of membranes (ROM) and mother-to-child HIV transmission (MTCT) rates in the era of combination antiretroviral therapy (cART).


DESIGN
The National Study of HIV in Pregnancy and Childhood (NSHPC) undertakes comprehensive population-based surveillance of HIV in pregnant women and children.


SETTING
UK and Ireland.


POPULATION
A cohort of 2398 singleton pregnancies delivered vaginally, or by emergency caesarean section, in women on cART in pregnancy during the period 2007-2012 with information on duration of ROM; HIV infection status was available for 1898 infants.


METHODS
Descriptive analysis of NSHPC data.


MAIN OUTCOME MEASURES
Rates of MTCT.


RESULTS
In 2116 pregnancies delivered at term, the median duration of ROM was 3 hours 30 minutes (interquartile range, IQR 1-8 hours). The overall MTCT rate for women delivering at term with duration of ROM ≥4 hours was 0.64% compared with 0.34% for ROM <4 hours, with no significant difference between the groups (OR 1.90, 95% CI 0.45-7.97). In women delivering at term with a viral load of <50 copies/ml, there was no evidence of a difference in MTCT rates with duration of ROM ≥4 hours, compared with <4 hours (0.14% for ≥4 hours versus 0.12% for <4 hour; OR 1.14, 95% CI 0.07-18.27). Among infants born preterm with infection status available, there were no transmissions in 163 deliveries where the maternal viral load was <50 copies/ml.


CONCLUSIONS
No association was found between duration of ROM and MTCT in women taking cART.


TWEETABLE ABSTRACT
Rupture of membranes of more than 4 hours is not associated with MTCT of HIV in women on effective ART delivering at term.
['Peters|H|H|', 'Byrne|L|L|', 'De Ruiter|A|A|', 'Francis|K|K|', 'Harding|K|K|', 'Taylor|G P|GP|', 'Tookey|P A|PA|', 'Townsend|C L|CL|']
D000328:Adult D044966:Anti-Retroviral Agents D004359:Drug Therapy, Combination D005321:Extraembryonic Membranes D005260:Female D015658:HIV Infections D006801:Humans D007231:Infant, Newborn D018445:Infectious Disease Transmission, Vertical D007743:Labor, Obstetric D011159:Population Surveillance D011247:Pregnancy D011251:Pregnancy Complications, Infectious D047928:Premature Birth D047929:Term Birth D013997:Time Factors D019562:Viral Load D055815:Young Adult
Duration of ruptured membranes HIV pregnancy mother-to-child transmission