Hepatitis C in Pregnancy

ABSTRACT

Hepatitis C is the most common cause of chronic liver disease and liver transplantation, with 25,000 cases reported in the United States per year. By blood product screening, transfusion-related viral transmission has been virtually eliminated, and maternal fetal transmission is now one of the most important modes of transmission. Hepatitis C virus (HCV) infection is blood borne but only 25% of the infected pregnant women indicate a history of blood products transfusion or intravenous drug use. HCV transmission is 2- to 4-fold higher in women coinfected with HIV. Although cesarean delivery has not been shown to decrease perinatal transmission, it may have benefits in women with viremia at the time of delivery. During pregnancy, treatment of HCV is contraindicated, even though perinatal transmission is associated with a higher incidence of chronic liver disease. This review gives an update on the disease agent, risk factors, modes of transmission, diagnosis, treatment modalities, and perinatal issues that require further evaluation.

KEYWORDS

Hepatitis C virus - pregnancy - perinatal transmission - cesarean delivery

REFERENCES

• 1 Armstrong G L, Wasley A, Simard E P et al.. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.  Ann Intern Med. 2006;  144 705-714
• 2 Berger A. Science commentary: behavior of hepatitis C virus.  BMJ. 1998;  317 440-441
• 3 Bell B P, Mast E E, Terrault N et al.. Centers for Disease Control and Prevention (CDC): prevention of hepatitis C in women.  Emerg Infect Dis. 2004;  10 2035-2036
• 4 Garfein R S, Vlahov D, Galai N et al.. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses.  Am J Public Health. 1996;  86 655-661
• 5 Alter M J. The epidemiology of acute and chronic hepatitis C.  Clin Liver Dis. 1997;  3 559-568
• 6 Ward C, Tudor-Williams G, Cotzias T et al.. Prevalence of hepatitis C among pregnant women attending an inner London obstetrics department: uptake and acceptability of named antenatal testing.  Gut. 2000;  27 277-280
• 7 Staples Jr C T, Rimland D, Dudas D. Hepatitis C in the HIV (human immunodeficiency virus) Atlanta V.A. (Veterans Affairs Medical Center) Cohort Study (HAVACS): the effect of co infection on survival.  Clin Infect Dis. 1999;  29 150-154
• 8 Seeff L B, Hoofnagle J H. The National Institutes of Health Consensus Development Conference Management of Hepatitis C 2002.  Clin Liver Dis. 2003;  7 261-287
• 9 Granovsky M O, Minkoff H L, Tess B H et al.. Hepatitis C virus infection in the mothers and infants cohort study.  Pediatrics. 1998;  102 355-359
• 10 Jabeen T, Cannon B, Hogan M et al.. Pregnancy and pregnancy outcome in hepatitis C type 1b.  Q J Med. 2000;  93 597-601
• 11 Resti M, Azzari C, Mannelli F et al.. Mother to child transmission of hepatitis C virus: prospective study of risk factors and timing of infection in children born to women seronegative for HIV-1.  BMJ. 1998;  317 437-441
• 12 Conte D, Fraquelli M, Prati D et al.. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women.  Hepatology. 2000;  31 751-755
• 13 Mok J, Pembrey L, Tovo P A, Newell M L. European Paediatric Hepatitis C Virus Network. When does mother to child transmission of hepatitis C virus occur?.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F156-F160
• 14 Zanetti A R, Tanzi E, Romano L et al.. Multicenter trial on mother-to-infant transmission of GBV-C virus. The Lombardy Study Group on Vertical/ Perinatal Hepatitis Viruses Transmission.  J Med Virol. 1995;  54 107-112
• 15 Gibb D M, Goodall R L, Dunn D T et al.. Mother-to-infant transmission of hepatitis C virus: evidence for preventable peripartum transmission.  Lancet. 2000;  356 904-907
• 16 Lin H H, Kao J H, Hsu H Y et al.. Possible role of high-titer maternal viremia perinatal transmission of hepatitis C virus.  J Infect Dis. 1994;  169 638-641
• 17 Minola E, Maccabruni A, Pacati I et al.. Amniocentesis as a possible risk factor for mother-to-infant transmission of hepatitis C virus.  Hepatology. 2001;  33 1341-1342
• 18 European Paediatric Hepatitis C Virus Network . Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus.  BJOG. 2001;  108 371-377
• 19 European Paediatric Hepatitis C Virus Network . A significant sex- but not elective cesarean section- effect on mother-to-child transmission of hepatitis C virus infection.  J Infect Dis. 2005;  192 1872-1879
• 20 Plunkett B A, Grobman W A. Elective cesarean delivery to prevent perinatal transmission of hepatitis C virus: A cost-effectiveness analysis.  Am J Obstet Gynecol. 2004;  191 998-1003
• 21 Steininger C, Kundi M, Jatzko G et al.. Increased Risk of mother-to-infant transmission of hepatitis C virus by intrapartum infantile exposure to maternal blood.  J Infect Dis. 2003;  187 345-351
• 22 Mast E E, Hwang L Y, Seto D S et al.. Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy.  J Infect Dis. 2005;  192 1880-1889
• 23 Azzari C, Resti M, Moriondo M et al.. Vertical transmission of HCV is related to maternal peripheral blood mononuclear cell infection.  Blood. 2000;  96 2045-2048
• 24 NIH Consensus Development Program. Management of Hepatitis C: 2002. Available at: http://www.consensus.nih.gov/2002/2002HepatitisC2002116main.htm Accessed September 6, 2006
• 25 Schuval S, Van Dyke R B, Lindsey J C et al.. Hepatitis C prevalence in children with perinatal human immunodeficiency virus infection enrolled in a long-term follow-up protocol.  Arch Pediatr Adolesc Med. 2004;  158 1007-1013
• 26 Perronne C, Carrat F, Bani-Sadr F et al.. RIBAVIC trial (ANRS HCO2): A controlled randomized trial of pegylated interferon alfa-2b plus ribavirin vs. interferon alfa-2b plus ribavirin for the initial treatment of chronic hepatitis C in HIV co-infected patients: preliminary results. Paper presented at: Fourteenth International AIDS Conference July 2002 Barcelona, Spain; Abstract LbOr16
• 27 Boskovic R, Wide R, Wolpin J et al.. The reproductive effects of beta interferon therapy in pregnancy: a longitudinal cohort.  Neurology. 2005;  65 807-811
• 28 Hiratsuka M, Minakami H, Koshizuka S, Sato I. Administration of interferon-alpha during pregnancy: effects on fetus.  J Perinat Med. 2000;  28 372-376
• 29 Mubarak A A, Kakil I R, Awidi A et al.. Normal outcome of pregnancy in chronic myeloid leukemia treated with interferon-alpha in 1st trimester: report of 3 cases and review of the literature.  Am J Hematol. 2002;  69 115-118
• 30 Mesquita M M, Pestana A, Mota A. Successful pregnancy occurring with interferon-alpha therapy in chronic myeloid leukemia.  Acta Obstet Gynecol Scand. 2005;  84 300-301
• 31 Sandberg-Wolheim M, Frank D, Giesser B et al.. Pregnancy outcomes during treatment with interferon beta-1a in patients with multiple sclerosis.  Neurology. 2005;  65 802-806
• 32 Strader D B, Wright T, Thomas D L et al.. Diagnosis, management, and treatment of hepatitis C.  Hepatology. 2004;  39 1147-1208
• 33 Sulkowski M S, Thomas D L. Hepatitis C in the HIV-infected person.  Ann Intern Med. 2003;  138 197-207
• 34 Sauleda S, Juarez A, Esteban J I et al.. Interferon and ribavirin combination therapy for chronic hepatitis C in human immunodeficiency virus-infected patients with congenital coagulation disorders.  Hepatology. 2001;  34 1035-1040
• 35 Yeung L T, King S M, Roberts E A. Mother-to-infant transmission of hepatitis C virus.  Hepatology. 2001;  34 223-229
• 36 Ferrero S, Lungaro P, Bruzzone B M et al.. Prospective study of mother-to-infant transmission of hepatitis C virus: a 10-year survey (1990-2000).  Acta Obstet Gynecol Scand. 2003;  82 229-234
• 37 Fischler B, Lindh G, Lindgren S et al.. Vertical transmission of hepatitis C virus infection.  Scand J Infec Dis. 1996;  28 353-356
• 38 Paccagnini S, Principi N, Massironi E et al.. Perinatal transmission and manifestation of hepatitis C virus infection in a high risk population.  Pediatr Infect Dis J. 1995;  14 195-199
• 39 Tovo P A, Palomba E, Ferraris G et al.. Increased risk of maternal-infant hepatitis C virus transmission for women coinfected with human immunodeficiency virus 1. Italian Study Group for HCV Infection in Children.  Clin Infect Dis. 1997;  25 1121-1124
• 40 Tajiri H, Miyoshi Y, Funada S et al.. Prospective study of mother-to-infant transmission of hepatitis C virus.  Pediatr Infect Dis J. 2001;  20 10-14
• 41 La Torres A, Biadaioli R, Capobianco T et al.. Vertical transmission of HCV.  Acta Obstet Gynecol Scand. 1998;  77 889-892
• 42 Ohto H, Terazawa S, Sasaki N et al.. Transmission of hepatitis C virus from mothers to infants. The Vertical Transmission of Hepatitis C Virus Collaborative Study Group.  N Engl J Med. 1994;  330 744-750
• 43 Lin H H, Kao J H, Hsu H Y et al.. Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers.  J Pediatr. 1995;  126 589-591