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

Abstract

Results: 13 of the 403 children had acquired hepatitis C virus infection at the end of follow up. All these children were born to women positive for hepatitis C virus RNA; none of the 128 RNA negative mothers passed on the infection (difference 5%, 95% confidence interval 2% to 7%). 6 children had viral RNA immediately after birth. 111 women had used intravenous drugs and 20 had received blood transfusions. 11 of the infected children were born to these women compared with 2 to the 144 with no known risk factor (difference 7%, 2% to 12%). Conclusions:This study suggests that in women not infected with HIV only those with hepatitis C virus RNA are at risk of infecting their babies. Transmission does seem to occur in utero, and the rate of transmission is higher in women who have had blood transfusions or used intravenous drugs than in women with no known risk factor for infection.

Maternal-infant transmission of hepatitis C virus infection

“…[33][34][35]38 Other studies do not confirm this finding. 15,27,28,30 Moreover, in some of the studies indicating increased risk with vaginal delivery, the difference fell short of statistical significance, including a large European study where mode of delivery was known for 1,400 infants. 24 Elective Cesarean section may confer some protection, but emergency Cesarean section does not.…”

“…In one study, pre-term delivery was quantitatively higher among anti-HCV positive women, but the difference was not statistically significant. 15 In the same series, Boxall, 1994 66 3,522 0.14 N/A Ohto, 1994 30 7,698 0.68 58 Marranconi, 1994 67 5,672 0.7 N/A Moriya, 1995 31 16,714 0.98 53 Zanetti, 1995 36 21,516 1.2 55 Manzini, 1995 68 5,000 0.7 ϳ70% Resti, 1998 27 25,654 the rate of Cesarean section was twice as high among anti-HCV positive women compared with the anti-HCV negative control group (statistically significant difference, P ϭ .004), and this higher rate was attributed in part to the policy of the investigators not to use fetal scalp blood sampling for fetal surveillance when fetal heart rate is abnormal in anti-HCV positive women.…”

“…Numerous, but by no means all, 27,28 studies indicate that the higher the concentration of serum HCV RNA the more likely mother-to-infant transmission. 23,[29][30][31][32][33] In one study, a high viral level was defined as at least 2.5 ϫ 10 6 viral RNA copies per mL, 33 but in general, studies showing a correlation of HCV transmission with maternal viral load exhibited the effect at 10 5 to 10 6 copies per mL.…”

Hepatitis C virus infection in children and adolescents

“…Likely risk factors include perinatal practices (fetal scalp monitoring and caesarean‐section delivery), extended exposure to maternal blood, high levels of HCV viremia during pregnancy, and co‐infection with human immunodeficiency virus (HIV) 15, 16, 17, 18, 19. Although some studies have challenged several of these assumptions,20, 21 a recent meta‐analysis concluded that maternal HIV co‐infection is the most important determinant of the risk of perinatal transmission 15…”

11.0 References

“…Both intrauterine and intrapartum infection probably occur, but the relative contribution of each is uncertain. However, approximately one-third of neonates are HCV-viraemic at birth suggesting acquisition in utero [192].…”