August 1994

Maternal-Newborn Human Immunodeficiency Virus Infection in Harlem

Author Affiliations

From the Department of Pediatrics (Drs Nicholas, Bateman, Dedyo, and Heagarty), Harlem Hospital Center, College of Physicians and Surgeons of Columbia University; and the American Health Foundation and Columbia University School of Public Health (Dr Ng), New York, NY.

Arch Pediatr Adolesc Med. 1994;148(8):813-819. doi:10.1001/archpedi.1994.02170080043007

Objective:  To determine the prevalence of human immunodeficiency virus type 1 (HIV-1) infection and its association with illicit drug use for mothers being delivered of infants at an inner-city municipal hospital.

Methods:  We anonymously tested the umbilical cord blood for HIV-1 antibody of 98.1% (2971/3028) of singleton infants with birth weight greater than 500 g born during 1989 and linked the results to a maternal-infant database from which all identifying information had been removed.

Results:  Overall, HIV-1 seroprevalence was 3.3% (99/2971). Among HIV-1–seropositive mothers, 79% (78/99) gave no history of ever using injected drugs. Seropositivity for HIV-1 was independently associated with history of maternal cocaine use during pregnancy (odds ratio, 3.55; 95% confidence interval, 2.18, 5.78), history of ever using injected drugs (odds ratio, 6.02; 95% confidence interval, 3.14,11.6), positive serologic test result for syphilis during pregnancy (odds ratio, 3.37; 95% confidence interval, 1.94, 5.88), and increasing maternal age per year (odds ratio, 1.04; 95% confidence interval, 1.00,1.09). Voluntary testing programs failed to identify 71% (70/99) of all HIV-1–infected women. Infants placed into foster care were eight times more likely to be HIV-1 seropositive than those discharged to their mothers.

Conclusions:  Most HIV-1–infected mothers seem to have acquired the infection via heterosexual transmission rather than via injected drug use. Associations of maternal HIV-1 infection with cocaine use, syphilis, and increasing age probably operate through behaviors that increase maternal risk of exposure to an HIV-1–infected sexual partner or, in the case of syphilis, also through biologic factors that may predispose to HIV-1 transmission. The failure of voluntary testing to identify most HIV-1–infected mothers provides a strong rationale for routine HIV-1 testing during pregnancy and in the newborn period.(Arch Pediatr Adolesc Med. 1994;148:813-819)