Background:  The number of women giving birth who were themselves perinatally infected with HIV is likely to increase. In New York State (NYS) the number of HIV-exposed births reached its zenith in 1990, with nearly 1900 HIV-infected women giving birth and an estimated 400 infants acquiring HIV. Many infected as infants are now attaining sexual maturity. Young pregnant perinatally infected women may have special medical requirements. This analysis describes a cohort of perinatally infected mothers (PIM) who gave birth in NYS between 2002 and 2006.

Methods:  The Newborn Screening Program tests all NYS infants for HIV antibodies. Prenatal, labor and infant charts of HIV-exposed infants are reviewed by the NYS Department of Health for programmatic monitoring. Data collected include demographics, maternal HIV risk, timing of maternal HIV diagnosis and antiretroviral treatment. 

Results:  HIV exposure was identified in 3330 birth events from January 2002 through December 2006. Chart abstraction data sufficient to complete analysis were available for 3107 (93%). Perinatal infection of the mother was identified in 48 mothers who delivered on 58 occasions (6 mothers delivered twice, and 2 mothers delivered on 3 separate occasions). The number of PIM has increased over time, from 4 (0.56%) of the 711 HIV-infected mothers in 2002 to 22 (3.89%) of the 565 HIV-infected mothers giving birth in 2006. Among the HIV-exposed birth events, Hispanic women were more likely to be PIM than white or black women; whereas 26% of HIV-exposed births were to Hispanic women, 28 of 58 (48%) births to PIM were Hispanic (OR 2.72, 95%CI 1.56 to 4.71). Caesarian section was more common among PIM than other HIV-infected mothers (OR 2.54, 95%CI 1.34 to 4.89). Otherwise, PIM and non-PIM had similar pregnancy outcomes. One PIM did not receive prenatal care. Infants <2500 g were born to 19% of PIM and 21% of non-PIM. PIM did not appear more likely to transmit HIV to their infants than non-PIM, with mother-to-child-transmission occurring in 2 of 58 PIM cases (3.4%) compared to 68 transmissions in the 3049 non-PIM (2.2%) (OR 1.57, 95%CI 0.18 to 6.15).

Conclusions:  The number of PIM progressively increased from 2002 to 2006. Although HIV transmission and birth weight outcomes of PIM do not appear to be significantly different than those in non-PIM deliveries, continued assessment of this growing subpopulation for emerging medical and psychosocial issues is reasonable.