Pathogenesis of Hepatitis C During Pregnancy and Childhood

Abstract

The worldwide prevalence of HCV infection is between 1% and 8% in pregnant women and between 0.05% and 5% in children. Yet the pathogenesis of hepatitis C during pregnancy and in the neonatal period remains poorly understood. Mother-to-child transmission (MTCT), a leading cause of pediatric HCV infection, takes place at a rate of <10%. Factors that increase the risk of MTCT include high maternal HCV viral load and coinfection with HIV-1 but, intriguingly, not breastfeeding and mode of delivery. Pharmacological prevention of MTCT is not possible at the present time because both pegylated interferon alfa and ribavirin are contraindicated for use in pregnancy and during the neonatal period. However, this may change with the recent introduction of direct acting antiviral agents. This review summarizes what is currently known about HCV infection during pregnancy and childhood. Particular emphasis is placed on how pregnancy-associated immune modulation may influence the progression of HCV disease and impact MTCT, and on the differential evolution of perinatally acquired HCV infection in children. Taken together, these developments provide insights into the pathogenesis of hepatitis C and may inform strategies to prevent the transmission of HCV from mother to child.

Prevalence of infections with potential for vertical transmission in pregnant women seen ata University Hospital in southern Brazil

“…A literatura tem associado um aumento de até quatro vezes no risco de transmissão vertical da hepatite C em mulheres co-infectadas pelo HIV passando de 5,5 para 25%. 25,26 Quanto aos fatores de risco para apresentar infecção durante a gestação, na análise bivariada podemos observar que as mulheres solteiras tiveram um risco 2 vezes maior de apresentar alguma infecção durante o período gestacional do que as casadas. No entanto, após a análise ajustada esse achado desapareceu.…”

Hepatitis C in children in times of change

“…The pathophysiology of HCV during pregnancy is incompletely understood. During pregnancy, the maternal immune system must protect both the mother and the fetus from HCV infection while tolerating paternal alloantigens, thus avoiding immunological attack on fetal cells [9]. How this is accomplished is unclear.…”

Ongoing transmission of HCV: Should cesarean section be justified? Data mining discovery

“…However, exposure to maternal blood can also occur with CS; accordingly, there is no reason to offer elective caesarean section to HCV-infected parturients [11][12][13][14] , with respect to special circumstances when CS is preferred to NVD, such as membranous rupture and internal fetal monitoring are confirmed to be associated with HCV transmission. CS and its complications were the main cause of death in many developing countries [15][16][17][18] . Egypt has the highest HCV prevalence worldwide; therefore, our results showed that the prevalence of HCV in a sample of Egyptian pregnant women was 2.08% (80 of 3,836 women), based on HCV Ab and PCR testing.…”