 |
|
Effect of Serologic Status and Cesarean Delivery on Transmission Rates of Herpes Simplex Virus From Mother to Infant
Zane A. Brown, MD;
Anna Wald, MD, MPH;
R. Ashley Morrow, PhD;
Stacy Selke, MS;
Judith Zeh, PhD;
Lawrence Corey, MD
JAMA. 2003;289:203-209.
Context Neonatal herpes most commonly results from fetal exposure to infected maternal genital secretions at the time of delivery. The risk of transmission from mother to infant as it relates to maternal herpes simplex virus (HSV) serologic status and exposure to HSV in the maternal genital tract at the time of labor has not been quantified. Furthermore, no data exist on whether cesarean delivery, the standard of care for women with genital herpes lesions at the time of delivery, reduces HSV transmission.
Objective To determine the effects of viral shedding, maternal HSV serologic status, and delivery route on the risk of transmission of HSV from mother to infant.
Design Prospective cohort of pregnant women enrolled between January 1982 and December 1999.
Settings A university medical center, a US Army medical center, and 5 community hospitals in Washington State.
Patients A total of 58 362 pregnant women, of whom 40 023 had HSV cultures obtained from the cervix and external genitalia and 31 663 had serum samples tested for HSV.
Main Outcome Measure Rates of neonatal HSV infection.
Results Among the 202 women from whom HSV was isolated at the time of labor, 10 (5%) had neonates with HSV infection (odds ratio [OR], 346; 95% confidence interval [CI], 125-956 for neonatal herpes when HSV was isolated vs not isolated). Cesarean delivery significantly reduced the HSV transmission rate among women from whom HSV was isolated (1 [1.2%] of 85 cesarean vs 9 [7.7%] of 117 vaginal; OR, 0.14; 95% CI, 0.02-1.08; P = .047). Other risk factors for neonatal HSV included first-episode infection (OR, 33.1; 95% CI, 6.5-168), HSV isolation from the cervix (OR, 32.6; 95% CI, 4.1-260), HSV-1 vs HSV-2 isolation at the time of labor (OR, 16.5; 95% CI, 4.1-65), invasive monitoring (OR, 6.8; 95% CI, 1.4-32), delivery before 38 weeks (OR, 4.4; 95% CI, 1.2-16), and maternal age less than 21 years (OR, 4.1; 95% CI, 1.1-15). Neonatal HSV infection rates per 100 000 live births were 54 (95% CI, 19.8-118) among HSV-seronegative women, 26 (95% CI, 9.3-56) among women who were HSV-1–seropositive only, and 22 (95% CI, 4.4-64) among all HSV-2–seropositive women.
Conclusion Neonatal HSV infection rates can be reduced by preventing maternal acquisition of genital HSV-1 and HSV-2 infection near term. It can also be reduced by cesarean delivery and limiting the use of invasive monitors among women shedding HSV at the time of labor.
Author Affiliations: Departments of Obstetrics and Gynecology (Dr Brown), Laboratory Medicine (Drs Wald, Morrow, and Corey and Ms Selke), Medicine, Statistics (Dr Zeh), and Epidemiology (Dr Wald), University of Washington, and the Program in Infectious Diseases, Fred Hutchinson Cancer Research Center (Drs Wald and Corey), Seattle.
RELATED ARTICLES IN JAMA
This Week in JAMA
JAMA. 2003;289:135.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Case 32-2005 -- A 34-Year-Old HIV-Positive Woman Who Desired to Become Pregnant
Riley and Yawetz
NEJM 2005;353:1725-1732.
FULL TEXT
Genital Herpes Complicating Pregnancy
Brown et al.
Obstet Gynecol 2005;106:845-856.
ABSTRACT
| FULL TEXT
Poor Correlation Between Genital Lesions and Detection of Herpes Simplex Virus in Women in Labor
Gardella et al.
Obstet Gynecol 2005;106:268-274.
ABSTRACT
| FULL TEXT
Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries
Mullick et al.
Sex Transm Infect 2005;81:294-302.
ABSTRACT
| FULL TEXT
A systematic review of the epidemiology and interaction of herpes simplex virus types 1 and 2
Looker and Garnett
Sex Transm Infect 2005;81:103-107.
ABSTRACT
| FULL TEXT
Impact of maternal stress on the transmammary transfer and protective capacity of herpes simplex virus-specific immunity
Yorty and Bonneau
Am. J. Physiol. 2004;287:R1316-R1324.
ABSTRACT
| FULL TEXT
Ethics of screening for asymptomatic herpes virus type 2 infection
Krantz et al.
BMJ 2004;329:618-621.
FULL TEXT
Patient satisfaction with care for genital herpes: insights from a global survey
Patrick et al.
Sex Transm Infect 2004;80:192-197.
ABSTRACT
| FULL TEXT
Genital Herpes
Kimberlin and Rouse
NEJM 2004;350:1970-1977.
FULL TEXT
Herpes Simplex Virus
Waggoner-Fountain and Grossman
Pediatr Rev 2004;25:86-93.
FULL TEXT
Neonatal Herpes Simplex Infection
Kimberlin
Clin. Microbiol. Rev. 2004;17:1-13.
ABSTRACT
| FULL TEXT
Use of Herpes Type-specific Serology to Prevent Neonatal Herpes Simplex Virus Infection
Brown
NeoReviews 2004;5:e16-21.
FULL TEXT
Once-Daily Valacyclovir to Reduce the Risk of Transmission of Genital Herpes
Corey et al.
NEJM 2004;350:11-20.
ABSTRACT
| FULL TEXT
Acyclovir Prophylaxis to Prevent Herpes Simplex Virus Recurrence at Delivery: A Systematic Review
Sheffield et al.
Obstet Gynecol 2003;102:1396-1403.
ABSTRACT
| FULL TEXT
Cesarean Delivery and Risk of Herpes Simplex Virus Infection--Reply
Brown et al.
JAMA 2003;289:2208-2209.
FULL TEXT
Cesarean Delivery and Risk of Herpes Simplex Virus Infection
Cohan
JAMA 2003;289:2208-2208.
FULL TEXT
Cesarean Delivery and Risk of Herpes Simplex Virus Infection
Rouse and Stringer
JAMA 2003;289:2208-2208.
FULL TEXT
Risk Factors for Perinatal Transmission of HSV
Rathore and Barton
AAP Grand Rounds 2003;9:26-26.
FULL TEXT
Cesarean Delivery Decreases Neonatal Herpes Transmission
Journal Watch Women's Health 2003;2003:2-2.
FULL TEXT
Neonatal Herpes: I Come Not to Bury Cesareans, but to Praise Them
Journal Watch Pediatrics and Adolescent Medicine 2003;2003:3-3.
FULL TEXT
Understanding Risk Factors for Neonatal Herpes Can Help Prevent It
Journal Watch Infectious Diseases 2003;2003:8-8.
FULL TEXT
|
