Obstetric management of hepatitis C-positive mothers: analysis of vertical transmission in 559 mother-infant pairs

The hepatitis C virus (HCV) is globally recognized as a serious public health concern. Current statistics indicate that approximately 2% of people worldwide and 1.9% of people in Poland suffer from HCV infection.This study was conducted to assess the anti-HCV seroprevalence in pregnant women in Poland and subsequently provide recommendations on the rationale for obligatory screening.A total of 42,274 women participated in our study, of which 16,130 were pregnant. We were granted access to their health data stored in the form of electronic medical records kept by the network of outpatient clinics throughout Poland.The lowest rate of positive anti-HCV test results was found in women ages 25 to 34 (0.73%); however, younger and older age groups had similar rates (15–24 = 0.86%; 35–44 = 0.84%). Additional analysis of data from the period between 2011 and 2014 revealed a downward trend in the proportion of positive anti-HCV tests among pregnant women (mean positive anti-HCV = −0.001 × year + 1.9451; R2 = 0.7274). Regardless of the gradual increase in the number of female patients undergoing screening between 2004 and 2015, there has been a constant decrease in the rate of positive cases. The rate of pregnant women potentially infected with HCV was twice as lower than that in a control group of women undergoing tests for other medical circumstances: 0.76% vs 1.67% (P < 0.0001).Analysis of real-world data of female patients in Poland provides evidence that screening based on an individual's medical history and behavioral risk factors in clinical circumstances would be more effective than obligatory testing of all pregnant women.

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“…Another insufficiently proven recommendation is cesarean delivery for HCV-positive women co-infected with HIV. [13] …”

Section: Discussionmentioning

confidence: 99%

Diagnosis of hepatitis C virus infection in pregnant women in the healthcare system in Poland

et al. 2016

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“…Rates of transmission have been shown to be as low as 0% to 3% when maternal HCV RNA was undetectable. 51,58,60 Women who are HCV negative but remain at high risk of acquisition should be educated regarding practices that decrease the risk of transmission. 3 Because the risk of sexual transmission is low, serodiscordant monogamous couples do not need to change their sexual practices, but should be tested regularly.…”

Section: Preventionmentioning

confidence: 99%

“…51,64 Invasive procedures, such as fetal scalp electrode or fetal scalp sampling, should be avoided, as these procedures have been shown to increase vertical transmission rates. 58 Evidence is lacking regarding the risk of transmission after amniocentesis, although no evidence suggests an increased risk.…”

Section: Treatmentmentioning

confidence: 99%

Prevention and Management of Viral Hepatitis in Pregnancy

Rac

Sheffield

2014

Obstetrics and Gynecology Clinics of North America

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“…[52][53][54] The mode of delivery does not affect risk of transmission, with similar rates of infection in infants delivered by cesarean section or vaginally. 55 The role of breastfeeding in HCV transmission has been controversial. However, most authorities agree that breastfeeding carries a very low risk of transmission provided that the nipple is undamaged.…”

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confidence: 99%

Management of chronic viral hepatitis in patients with thalassemia: recommendations from an international panel

Marco

Capra²,

Angelucci³

et al. 2010

Blood

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IntroductionIn the last 4 decades, regular blood transfusions and chelation therapy have improved the survival of patients with thalassemia major. 1-3 Despite the progress on chelation therapy, cardiac complications remain the main cause of death among transfusiondependent thalassemia patients related to the susceptibility of cardiac cells to iron overload toxicity. 4,5 The interest in the clinical management of chronic liver diseases has been increasing, however, because of the high prevalence of viral infections in adult transfusion-dependent thalassemia patients and the central role of the liver in regulating the iron metabolism. 5,6 The assessment of heart and liver iron overload is required to tailor iron chelation therapy. Furthermore, the diagnosis of hepatitis B virus (HBV)-or hepatitis C virus (HCV)-related chronic hepatitis is required to identify patients who have a high risk of developing liver complications and who may obtain a benefit by antiviral therapy.The goals of this paper are to summarize the epidemiology and the risks of transmission of viral infections, to analyze invasive and noninvasive methods for the diagnosis of chronic liver disease, to report the knowledge on clinical course of chronic viral hepatitis, and to suggest the management of antiviral therapy. For personal use only. on May 12, 2018. by guest www.bloodjournal.org From An expert hepatologist prepared an initial draft based on systematic review of published literature by Medline search on viral hepatitis in thalassemia patients, examined recently published guidelines on the diagnosis, management, and treatment of chronic hepatitis B and chronic hepatitis C edited by the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian-Pacific Association for the Study of the Liver 7-10 and the Consensus Development Conference sponsored by the National Institutes of Health. 11 Recommendations of the panel of experts were based insofar as possible on evidence from publications that reported data on thalassemia patients. If evidence from thalassemia patients was unavailable, the panel selected recommendations from published guidelines that were suitable for thalassemia patients. Recommendations were evaluated according to the Grading of Recommendations Assessment Development and Evaluation system and classified into 3 levels: high, moderate, or low 12 (Table 1). For each recommendation, the level of evidence (high, moderate, or low) and population studied (general population of patients with viral chronic hepatitis or thalassemia patients) was specified. The panel of experts discussed the draft issue by issue, and 3 experts on blood transfusion, iron metabolism, and viral hepatitis management reviewed the recommendations. Finally, 8 international external experts in pediatrics, hematology, and viral hepatitis reviewed and criticized the recommendations. Methods Results What proportion of thalassemia patients have chronic viral infections?Worldwide, from 0.3% to 5.7% of thala...

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Obstetric management of hepatitis C-positive mothers: analysis of vertical transmission in 559 mother-infant pairs

Cited by 34 publications

References 30 publications

Diagnosis of hepatitis C virus infection in pregnant women in the healthcare system in Poland

Diagnosis of hepatitis C virus infection in pregnant women in the healthcare system in Poland

Prevention and Management of Viral Hepatitis in Pregnancy

Management of chronic viral hepatitis in patients with thalassemia: recommendations from an international panel

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