Hepatitis C and pregnancy.

Belopolskaya Maria

Botkin Infectious Diseases Hospital St Petersburg

Russia2012

Prevalence of chronic hepatitis C infection in the world

http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hepatitis-c.htm

21,116,5

4,1 2,8

89,2

57,2

4,54,85,3

3,62,2 2,1

7,2

22,115,2 15,1 12,9

7,5 5,5 3,74,29,7

0

10

20

30

40

50

60

70

80

90

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Russia SPb

Incidence HCV per 100 000 population

Prevalence of HCV-antibody

Pregnant women have a prevalence of HCV-antibody similar to that at population.

In the world the prevalence of antibody to HCV (anti-HCV) in pregnant women is 0.1% to 2.4%.

In Russia 2.8% of pregnant women have HCV-infection.*

*Ershova O.N. et al., 2005

Mother-to-infant transmission

The rate of mother-to-infant transmission is 4% to 7% per pregnancy when HCV viremia is presented.

43,0%

25,0%

0,2%

1,0%

3,0%

1,0%

14,0%

ChHBV ChHCV mixt ChHAIH NIH Vilson diseaseanother

Hepatic disease in childhood Research Institute of Children's Infections

Screening for chronic HCV infection

In Russia we have routine screening of pregnant women for chronic HCV infection twice during pregnancy: at 1st and 3rd trimesters. Due to this screening we can detect acute forms of HCV-infection during pregnancy.

Benefits of total screening

Observation for women with HCV-infection during pregnancy and after delivery.

Observation for children born from mothers with HCV-infection.

HCV diagnosis of pregnant women

beforepregnancy at time of

pregnancy

0

1020

30

40

50

60

70

80

%

1 pregnancy

2 and more

Possible modes of transmission HCV in a cohort of pregnant women in SPb (n=169)

15%

6%

72%

7%

Intravenous drug use

Sexual transmission

no identifiable riskfactor

iatrogenic risk factors

Clinical course

In the many cases pregnancy does not worsen the course of the chronic HCV-infection. Women with high ALT level in 1st trimester usually have normal level at the 3rd. But after delivery we often see high value of ALT, even higher than before pregnancy (if HCV-RNA+).

ALT level in RNA HCV-positive women

0

20

40

60

80

100

120

1st 2nd 3rd after delivery

Level

AL

T (

IU\m

l)

Routes of HCV transmission

Transplacental transmission in uterus (antenatal transmission)

Transmission during delivery Postnatal transmission – through breast-

feeding or during child-care

Risk factors of vertical HCV transmission (viral factors)

Co-infection HIV increases vertical transmission risk 2–3-times, although this risk can be decreased with administration HAART during pregnancy

Levels of HCV viral load: non-viraemic women have very low risk; high viral load increases vertical transmission risk

HCV-RNA in peripheral blood mononuclear cells increases risk of vertical transmission

According to our data in 2011

N=112

HCV-RNA+ 75 (67%)

viral load 10(5) - 10(6) IU/ml

HCV-RNA- 37 (33%)

ALT> 80U/l after delivery 27 (24%)

Risk factors of HCV vertical transmission (obstetric factors)

Mode of delivery: There is no protective effect of cesarean delivery on HCV vertical transmission compared with vaginal delivery

Obstetric procedures: prolonged rupture of membranes may increase risk, amniocentesis unlikely to increase risk

Prematurity: No evidence of effect Gender: doubles the risk for girls compared with

boys

Breast feeding

No evidence of increased risk through breastfeeding

According to our data HCV RNA can be detected in breast milk from women with high viral load (7% when HCV RNA>10(6)IU/ml)

Frequency of vertical HCV transmission Research Institute of Children's Infections, SPb

7,28,2

10,3 10,4

6,7

0

2

4

6

8

10

12

%

2005 2007 2008 2009 2011

Effect of chronic HCV-infectionon the course and outcomes of pregnancy

•HCV-infection does not affect the reproductive function, the frequency of spontaneous abortions•No effect on the incidence of congenital anomalies •An effect on the course ofpregnancy (frequency of fetal malnutrition, premature birth) depends on the liver disease severity •There exists a risk of vertical transmission

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