The management of HCV-infected pregnant women

Perinatal transmission of hepatitis C virus: an update

“…Another maternal obstetric complication of HCV is the earlier and more frequent development of cholestasis in HCV infected than non-infected women, which could be attributed to the altered transport of sulfated hormones in the liver, a failure in the transport of toxic substances, and a defect of the bile salt export pump [24,[85][86][87].…”

“…Although HCV-RNA is detectable in colostrums [31] and theoretical transmission may be possible through breast feeding, discouraging breast feeding in HCV-infected mothers is not recommended [9,23,79,86,128], as there is no proof of any increase in the risk of HCV transmission with breast-feeding [105]. The European Paediatric Hepatitis C Virus Network [21] noted no difference in infection rates in breast-versus formula-fed infants in a study carried out on 1,758 infants born to HCV-infected mothers.…”

“…They studied the effect of variables including HCV genotype, temperature, and milk from different species on the breast milk antiviral effect High maternal serum viral load at the time of delivery as it indicates active viremia [18-20, 105, 106]. The risk is proportionate to the increase in levels of viral load above 105 IU/ml [19,107] and reaches a maximum at levels above 107 IU/ml [108] High maternal serum ALT levels in the 12 months before pregnancy and/or at the time of delivery as it is considered a reflection of higher viral replication rate [23,101] that may cause more extensive hepatic damage and subsequently elevated ALT [79,[109][110][111] Rupture of membranes > 6 h [9,23,86,107] Prolonged and/or difficult deliveries [112] Fetal sex remained the only risk factor significantly associated with HCV perinatal transmission, with girls as twice as likely to be infected as boys in one study [113] and 8 to 3 in another study [114]. This finding likely reflects hormonal or genetic differences in susceptibility or response to infection.…”

Hepatitis C in children: Clinical outcome, route of infection and diagnosis

“…The factors predicting the risk include human immunodeficiency virus coinfection, history of intravenous drug use, maternal disease activity (high alanine transaminase concentrations), and HCV infection of the father/sexual partner of the mother. The mode of delivery, previous delivery of a child infected perinatally with HCV, breast-feeding, genotype and mother -child human leukocyte antigen concordance are not associated with increased risk [15,17,18].…”

Variation of Transaminases, HCV-RNA Levels and Th1/Th2 Cytokine Production during the Post-Partum Period in Pregnant Women with Chronic Hepatitis C

“…Some studies have reported obstetrical complications in HCV-infected pregnant women (premature rupture of membranes, preterm delivery, low new-born weight, cholestasis) [9]–[12], but others have concluded that, in the absence of cirrhosis and portal hypertension, most HCV-infected pregnant women do not experience obstetric complications [6], [13], [14]. During pregnancy, the treatment of HCV is contraindicated, and therefore there are no antiviral treatment recommendations for HCV-infected women during pregnancy, or guidelines for the prevention of vertical transmission, even though perinatal transmission is associated with a higher incidence of chronic liver disease [15]. Parity, hormone replacement therapy for postmenopausal women and the female sex have all been reported as protection factors against the progression of liver disease to cirrhosis, because the female hormones (oestrogen, progesterone) might play a role in delaying the onset of hepatic fibrosis [16]–[19].…”