The prevalence of hepatitis C virus (HCV) infection in pregnant women has been extensively investigated, and the frequency of anti-HCV positivity has been reported as ranging from 0.7% to 4.4%, 1-7 with a rate of viremia of 63% to 69%. 5,7,8 However, there are only a few published studies concerning the course of chronic HCV infection during pregnancy, and possible variations in the proportion of HCV-RNA-positive subjects and the pattern of transaminase levels. 9,10 This information could be useful in the clinical management of HCV-infected women both during and after pregnancy.The vertical transmission of HCV has been evaluated in a number of studies and found to range from 0% to the 20% observed in one series, 11 with the overall mean rate being about 5%. 1,7,8,[11][12][13][14][15] However, given the decline in the risk of posttransfusion hepatitis 16,17 and the very low rate of the sexual transmission of HCV, 18 the epidemiological relevance of mother-to-child transmission is expected to increase in the future, and this will have obvious consequences in terms of counseling for pregnant women. Furthermore, controversy still exists concerning the route of HCV vertical transmission (in utero or perinatal) and the possible related risk factors.The aim of the present study was to evaluate the prevalence and natural course of chronic HCV infection in 15,250 consecutive pregnant women, and to estimate the rate of HCV vertical transmission.

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In a subset of patients attending liver units, a chronic increase in serum transaminases may remain of undetermined cause despite thorough investigations. On the other hand, elevated levels of serum transaminases have been reported in about 40% of adult celiac patients. To evaluate the prevalence of subclinical celiac disease in patients with chronic unexplained hypertransaminasemia in comparison with that in the general population (0.5%), 140 consecutive patients with chronic increases of serum transaminases levels of unknown cause were tested for antigliadin and antiendomysium IgA antibodies. All patients with positive antibody tests were offered upper gastrointestinal endoscopy with distal duodenal biopsy. Thirteen patients (9.3%, 95% confidence interval 5.0-15.4) had positive antigliadin and antiendomysium antibodies. The prevalence of antibodies was 17% in women and 5.4% in men (8/47 vs. 5/93 respectively; relative risk 3.2, 95% confidence interval 1.1-9.1). Distal duodenal biopsy performed in all but one of the patients showed mild villous atrophy with increased intraepithelial lymphocytes in three cases, subtotal villous atrophy in six, and total villous atrophy in three. The prevalence of celiac disease in the patient group was significantly higher than that in the general population (P F .001) with a relative risk of 18.6 (95% confidence interval 11.1-31.2). On the basis of the present findings, screening for celiac disease is an important tool in the initial diagnostic work-up of patients with chronic unexplained hypertransaminasemia. (HEPATOLOGY 1999:29;654-657.)