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

Abstract

Background and Objectives:Over the past few decades, cesarean section (CS) rates are steadily increasing in most of the middle-and high-income countries. However, most of the pregnant women (particularly undergoing CS) are not screened for hepatitis C virus (HCV); hence, neonates born to HCV-positive mother could be a source of future HCV infection. In this study, the role of the CS and other surgical interventions in HCV transmission in Egypt, the highest endemic country of HCV-4, was investigated. Methods: From January to June 2016, a prospective cohort study was conducted among 3,836 pregnant women in both urban and rural areas across Egypt for HCV screening in both mothers and neonates born to HCV-positive mother. All pregnant women were screened during third trimester or just before delivery, neonates born to HCV-positive mothers were evaluated within 24-h postdelivery to record vertical transmission cases. Data mining (DM)-driven computational analysis was used to quantify the findings. Results: Among 3,836 randomized pregnant women, HCV genotype 4 was identified in 80 women (2.08%). Out of 80 HCV-infected women, 18 have experienced surgical intervention (22.5%) and 62 CS (77.5%). HCV vertical transmission was identified in 10 neonates, 10/80 (12.5%). Conclusion: Screening women who had experienced surgical intervention or CS during child bearing period and before pregnancy might prevent HCV mother-to-child transmission (MTCT). CS should be ethically justified to decrease global HCV transmission.

Hepatitis C Virus Infection in Children and Pregnant Women: An Updated Review of the Literature on Screening and Treatments

“…Although it has not yet been clarified whether elective cesarean section can reduce the risk of HCV MTCT, elective cesarean delivery should be ethically justified to decrease global HCV transmission. 63 In the case of women with pre-existing antibodies but HCV RNA negative, artificial insemination may also be considered safe. Transmission cases have been described only in case of positive PCR (HCV RNA þ ).…”

Review article: direct‐acting antivirals for the treatment of HCV during pregnancy and lactation ‐ implications for maternal dosing, foetal exposure, and safety for mother and child

“…In addition to high maternal HCV viral load and having HIV, membrane rupture for more than 6 hours before delivery and internal foetal monitoring (uterine or foetal scalp) have been reported to contribute to an increased risk of vertical HCV transmission . Currently, most studies suggest that the risk of transmission may be reduced by elective caesarean section, particularly in the case of HCV/HIV co‐infection . Based on timing of positive HCV RNA test results in the newborn, timing of transmission is thought to occur during intrauterine, peripartum and postpartum periods .…”