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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, 3.4m; 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., Most HIV-1-infected mothers giving birth at a Harlem hospital acquired their infection through heterosexual sex. Ninety-eight percent of the 3028 liveborn infants weighing over 500 grams born during 1989 were tested. Of them, 3.3% were HIV-positive. Among positive mothers, 79% had no history of using injected drugs. Mothers with an HIV-infected newborn were 3.5 times more likely to have used cocaine, 6 times more likely to have injected drugs, 3.4 times more likely to test positive for syphilis, and were likely to be older than mothers of HIV-negative infants. The association with maternal cocaine use and syphilis and suggests sexual transmission as the major infection route. Voluntary testing failed to identify 71% of the infected mothers. Routine HIV testing in pregnancy and in newborns is recommended.

Objective: To determine the maternal risk factors and infant outcome for unattended out-of-hospital deliveries brought to an inner-city public hospital. Methods: We compared 59 infants born alive out of hospital during 1989 with 151 randomly selected in-hospital live births, all with birth weight greater than 500 g. Results: History of cocaine use during pregnancy (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.68 to 10.5) and lack of Medicaid or other health insurance (OR, 2.15; 95% CI, 1.04 to 4.45) were independently associated with out-of-hospital delivery. Out-of-hospital delivery was associated with hypothermia (defined as admission axillary temperature 0.65 at age [greater than or equal to] 6 hours) occurred in 14% (eight of 59) of out-of-hospital births. The increased neonatal mortality rate for infants born out of hospital (20.3 vs 7.3 per 1000 live births; OR, 2.82; 95% CI, 1.23 to 6.47) was due to an excess of infants weighing 500 to 999 g. Conclusions: Unattended out-of-hospital births result in increased neonatal morbidity that may be partly preventable by simple interventions used routinely at in-hospital deliveries., Maternal risk factors including illegal drug use, a lack of health insurance, and inadequate prenatal care may be associated with non-hospital delivery of newborns. Reducing these risk factors may decrease the rate of non-hospital births and subsequently improve the health of newborns. During 1989, researchers studied 151 infants born in Harlem Hospital and 59 babies delivered in a non-hospital setting who were then admitted to Harlem Hospital. Maternal characteristics independently associated with non-hospital delivery included cocaine use during pregnancy and a lack of health insurance. Inadequate prenatal care, HIV infection, prior pregnancy, syphilis infection, and illegal drug use during pregnancy were more common in women with non-hospital delivery. Babies born outside the hospital tended to have lower body temperature, blood sugar, and birth weights than their hospital-born counterparts.