Changing epidemiology, implications, and recommendations for hepatitis C in women of childbearing age and during pregnancy

Abstract

Despite the remarkable advances in HCV treatment brought about by the advent of direct-acting antivirals, HCV remains a global public health concern. One particular concern relates to the rising prevalence of HCV in women of childbearing age. Active HCV during pregnancy is associated with cholestasis of pregnancy as well as the risk of mother-to-child transmission. Guidelines are increasingly recommending universal screening during pregnancy, while the treatment of HCV during pregnancy is an area of ongoing research.

Prevalence and Predominant Genotype of Hepatitis C Virus Infection and Associated Risk Factors among Pregnant Women in Iran

“…If HCV RNA is present in the mother's blood, the rate of vertical transmission is about 4.3% [ 6 , 8 ]. Moreover, in HIV-infected mothers, the rate of vertical transmission increases to 10.8% [ 9 , 10 ]. Although the high maternal viral load is an important factor for the perinatal transmission of HCV, this risk factor is not preventable, as no anti-HCV treatment can currently be prescribed to pregnant women to prevent HCV from replicating [ 7 ].…”

“…Therefore, the rate of maternal-fetal transmission of HCV varies in different geographical regions. Universal HCV screening during pregnancy is recommended to provide the best pregnancy management interventions to reduce the risk of perinatal HCV transmission [ 10 , 14 ]. The prevalence of HCV in Iran ranges from 0.5% (95% CI: 0.4–0.6%) in blood donors to 0.6% (95% CI: 0.4% to 0.8%) in the general population [ 15 , 16 ].…”

SARS-CoV-2 in Pregnancy: Fitting Into the Existing Viral Repertoire

“…Much of the disease burden data come from the United States, where the elevated incidence of HCV aligned with the opioid epidemic. The HCV burden increased in IDU-associated HCV cases in the younger population, consisting of women who were pregnant and of reproductive age ( 79 ). There are geographical inequities in HCV healthcare management, and the prevalence thus varies across the globe.…”

“…In the US, the incidence is 3.6% ( 84 ), whereas in Spain it is 7% ( 85 ) in HCV/HIV co-infected pregnant women. In spite of these statistics, the true estimate is still a challenge owing to the availability of scarce information on the subject and also the substantial time gap between childbirth and testing for HCV antibodies (currently recommended at ≥18 months of age), which may lead to loss of contact with the cases to be examined ( 79 ). The mode of delivery or breastfeeding does not appear to impact the risk of HCV transmission, while the prolonged duration of ruptured membranes may be a risk factor for the same ( 86 ).…”

“…The mode of delivery or breastfeeding does not appear to impact the risk of HCV transmission, while the prolonged duration of ruptured membranes may be a risk factor for the same ( 86 ). The association between the viral load and vertical transmission of HCV is under speculation, but conclusive recommendations cannot be made due to insufficient data ( 79 ).…”