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Children born to women known to be infected with human immunodeficiency virus type 1 (HIV-1) before delivery were followed prospectively from birth in nineteen European centres. This analysis, encompassing the period end-December, 1984, to beginning-August, 1991, focuses on risk factors for mother-to-child transmission of HIV-1 infection. Rate of vertical transmission, based on 721 children born to 701 mothers more than 18 months before the time of analysis, was 14·4% (95% Cl 12·0-17·1%). Transmission was associated with maternal p24-antigenaemia and a CD4 count of less than 700/μl. In a multivariate analysis, odds ratios of transmission were: 2·25 (95% Cl 0·97-5·23) in breastfed children vs never-breastfed children; 3·80 (1·62-8·91) in children born before 34 weeks' gestation; and 0·56 (030-1·04) in children delivered by caesarean section. Transmission was higher with vaginal deliveries in which …