Chronic hepatitis C virus infection is associated with increased risk of preterm birth: a meta‐analysis of observational studies

Abstract

Although several epidemiological studies reported that maternal chronic hepatitis C virus (HCV) infection had significantly increased risk of undergoing adverse obstetrical and perinatal outcomes, studies on the relationship between HCV infection and risk of preterm birth (PTB) have yielded inconclusive and inconsistent results. Therefore, we conducted a meta-analysis to investigate the association between HCV infection and PTB. The electronic database was searched until 1 September 2014. Relevant studies reporting the association between HCV infection and the risk of PTB were included for further evaluation. Statistical analysis was performed using revmen 5.3 and stata 10.0. Nine studies involving 4186698 participants and 5218 HCV infection cases were included. A significant association between HCV infection and PTB was observed (odds ratio = 1.62, 95% CI 1.48-1.76, P < 0.001, fixed-effects model). Stratification according to maternal smoking/alcohol abuse, maternal drug abuse or coinfected with HBV and/or HIV matched groups still demonstrated that women with HCV infection had a high risk for PTB. Findings from our meta-analysis suggested that maternal HCV infection was significantly associated with an increased risk of PTB. In the future, pathophysiological studies are warranted to ascertain the causality and explore the possible biological mechanisms involved.

Review article: direct‐acting antivirals for the treatment of HCV during pregnancy and lactation ‐ implications for maternal dosing, foetal exposure, and safety for mother and child

“…Ideally, treatment would be completed before delivery. In that case, taking into account that women living with HCV may deliver preterm, the optimal time period to start DAA treatment may be at the end of the second trimester (at around week 23/24 of gestation) or early third trimester (at around 27/28 weeks of gestation), in case of a 12‐ or 8 week treatment period respectively, and may have to be extended until after delivery to complete treatment. For late presenters (>28 weeks of gestation), treatment may still be effective as DAAs cause a rapid viral decline, resulting in undetectable HCV RNA in just 2‐4 weeks …”

“…These studies report an association between maternal HCV infection and the risk of gestational diabetes and intrahepatic cholestasis of pregnancy . In addition, an increased risk of preterm birth was reported and children born to women living with HCV were more likely to have a lower birth weight and to be small for gestational age …”

HCV in Women and Pregnancy

“…(6) The global prevalence is similar, with 71 million persons chronically infected (about 1%). (7) With increases in injection drug use, HCV demographics are changing from a birth cohort illness to a bimodal disease with an incidence peak in those aged [25][26][27][28][29][30][31][32][33][34][35] and increased exposure of reproductive age women to HCV. (8,9) Increased maternal HCV infection is associated with white race, rural demographics, lower education, cigarette smoking, and concurrent HBV infection.…”

“…Adverse neonatal outcomes have been described, although concerns remain about confounding. Increases in preterm labor/preterm delivery (32% (34) to 62% (35) ), intra-uterine growth retardation (53%), and low birth weight (97%) (36) have been reported. These findings persist after controlling for maternal age, tobacco use, alcohol abuse, and drug abuse.…”

Viral hepatitis vaccination during pregnancy

“…18,116 Maternal and neonatal outcomes, including gestational diabetes, preterm delivery, and low birth weights, have been reported. [117][118][119][120] In addition, vertical transmission plays a major role in pediatric hepatitis C 121 ; the prevalence of mother-tochild transmission from HCV-infected women without HIV infection is an estimated 2-8%, 18,115,122,123 and 2-3 times higher in mothers co-infected with HIV. [124][125][126][127] There is currently no vaccine for hepatitis C, 15,128 and immune globulin is not effective in preventing pre-or postexposure HCV infection.…”