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Mother-to-infant transmission of hepatitis C virus (HCV) is comparatively uncommon. The prevalence of antibody to HCV (anti-HCV) in pregnant women is 0.1% to 2.4%, although in some endemic areas it is much higher. The proportion of women with anti-HCV who have active infection with viremia is 60% to 70%. Transmission of HCV occurs only when serum HCV RNA is detectable and may be related to higher levels (above 10 6 copies per mL). M aternal and child health issues relating to hepatitis C virus (HCV) infection have recently assumed greater importance than ever before. From the pediatric perspective, the availability of effective screening methods for HCV has virtually eliminated new cases of transfusion-associated hepatitis C in children. Consequently, childhood acquisition of HCV infection through maternal-infant transmission has become the most important mode of spread. 1 Vertical, or more precisely, mother-to-infant hepatitis C will likely be the major type of childhood chronic hepatitis C within the next 6 to 8 years. It has been difficult to determine the rate of mother-to-infant transmission, partly because reports of mother-to-infant transmission of HCV have been based on small numbers of patients, with differing disease definitions, followed with different study designs and using different virological assays. These reports tended to be heterogeneous and conflicting. Moreover, factors that promote mother-to-infant transmission and the outcome of chronic HCV infection acquired by this route still require clarification. Likewise, for women of child-bearing age who acquired chronic hepatitis C in childhood or in early adulthood, there are important issues relating to pregnancy itself, such as its effect on the disease course of chronic hepatitis C. Prevalence of Hepatitis C Among Pregnant WomenNumerous studies have examined the prevalence of hepatitis C among pregnant women (Table 1). The studies vary considerably in terms of the size of the study, geographic variables, and adequacy of laboratory testing. In general, the prevalence of detectable antibody to HCV (anti-HCV) is approximately 1% overall (range, 0.1% to 2.4%), based on the studies that included at least 3,000 subjects. The mean Abbreviations: HCV, hepatitis C virus; anti-HCV, antibody to HCV; ALT, alanine aminotransferase; HIV, human immunodeficiency virus.

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To describe the spontaneous clearance rate of childhood hepatitis C virus (HCV) infection, to determine whether route of transmission affects the clearance rate and to identify other predictors of clearance. Children with chronic hepatitis C were identified between 1990 and 2001. The rate of spontaneous clearance (defined as >or=2 positive anti-HCV antibody test but negative HCV RNA) was calculated using survival analysis. Univariate and multivariate predictor variables [route of transmission, age at infection, age at last follow-up, alanine aminotransferase (ALT) and gender] for clearance were evaluated. Of 157 patients, 28% of children cleared infection (34 transfusional and 10 nontransfusional cases). The 123 transfusional cases were older at time of infection and at follow-up, compared with the 34 nontransfusional cases. Younger age at follow-up (p < 0.0001) and normal ALT levels (p < 0.0001) favoured clearance. Among cases of neonatal infection, 25% demonstrated spontaneous clearance by 7.3 years. The rate of spontaneous clearance of childhood HCV infection was comparable between transfusional and nontransfusional cases. If clearance occurs, it tends to occur early in infection, at a younger age.