Loading ...
Sorry, an error occurred while loading the content.

HCV & Pregnancy

Expand Messages
  • claudine intexas
    NATAP - www.natap.org HCV & Pregnancy; c-section may reduce HCV transmission; use of forceps in vaginal delivery may increase risk of transmission The findings
    Message 1 of 1 , Jul 22 6:19 PM
    • 0 Attachment
      NATAP - www.natap.org

      HCV & Pregnancy; c-section may reduce HCV
      transmission; use of forceps
      in
      vaginal delivery may increase risk of transmission

      The findings in three studies outlined below suggest
      that caesarean
      section
      delivery was associated with reduced risk of
      transmitting HCV from
      mother to
      child. The study also found that vaginal delivery
      using forceps was
      associated with a greater risk of HCV transmission
      from mother to
      child.
      Similar to HIV exposing the infant to higher amounts
      of maternal
      secretions
      or fluids may increase the risk of transmission to the
      child.

      One of the studies finds that C-section reduced HCV
      transmission from
      mother
      to child by 60% in HCV/HIV coinfected mothers, but
      C-section in
      HCV-alone
      infected women did not reduce transmission of HCV.
      Women who breastfed
      were 4
      times more likle to transmit HCV. Coinfected women
      were twice as likely
      to
      transmit HCV than HCV monoinfected.

      C-Section May Reduce HCV Transmission
      (Gastroenterology April 18 2001)

      --HCV transmission 6.7% when HCV-monoinfected but
      18.6% when mother was
      coinfected with HIV
      --Newborns clear mothers antibodies slowly: 50% of
      unifected children
      remained HCV+ at 8 months of age and 5% were HCV+ at
      13 months
      --HCV-PCR was positive in only 22% at month of age but
      positive in 97%
      after
      1 month
      --It appears children delivered by C-section before
      membrane rupture
      had a
      lower incidence of
      getting HCV than when vaginal delivery was used,
      although it was not
      statistically significant. But other researchers
      questioned the results
      (Lancet 2001 volume 356)

      The mechanisms whereby hepatitis C is transmitted from
      mother to child
      are
      poorly delineated. Gibb et al. evaluated data from 3
      hospitals in
      Ireland and
      from a British pediatric surveillance study to provide
      estimates of the
      rate
      of mother-to-infant transmission of hepatitis C, and
      to identify risk
      factors
      for transmission of the virus. A total of 441
      mother-infant pairs in
      which
      the mother was known to be infected with hepatitis C
      during pregnancy
      (92%),
      or the child was found to be positive for the
      hepatitis C virus within
      90
      days of birth (8%), were analyzed longitudinally. The
      overall rate of
      vertical transmission of hepatitis C in this study was
      6.7%, increasing
      to
      18.6% in mothers coinfected with HIV. The slow
      clearance of maternal
      antibodies in infants born to hepatitis C-infected
      mothers is
      highlighted by
      the finding that half of uninfected children remained
      seropositive at 8
      months of age and 5% continued to be seropositive at
      13 months.
      Conversely,
      hepatitis C RNA was identified by polymerase chain
      reaction (PCR) in
      only 22%
      of infected neonates younger than 1 month, but was
      detected in 97% of
      infected infants after that time period. Newborns
      delivered by cesarean
      section had a lower, albeit nonsignificant, incidence
      of acquiring the
      hepatitis C virus than those undergoing vaginal
      delivery. However, a
      significantly diminished rate of vertical transmission
      was noted when
      infants
      delivered by elective cesarean section were compared
      with the combined
      group
      of children delivered vaginally or by emergency
      cesarean section. In
      fact,
      none of the 31 children delivered by elective cesarean
      section became
      chronically infected. Rates of hepatitis C in
      breast-fed infants were
      no
      different than in infants who were exclusively
      bottle-fed.

      Effects of mode of delivery and infant feeding on the
      risk of
      mother-to-child
      transmission of hepatitis C virus. European Paediatric
      Hepatitis C
      Virus
      Network.

      European Paediatric Hepatitis C Virus Network.

      OBJECTIVE: To investigate the effects of mode of
      delivery and infant
      feeding
      on the risk of mother-to-child transmission of
      hepatitis C virus.
      DESIGN:
      Pooled retrospective analysis of prospectively
      collected data. SAMPLE:
      Data
      on hepatitis C virus seropositive mothers and their
      children identified
      around delivery were sent from 24 centres of the
      European Paediatric
      Hepatitis C Virus Network.

      MAIN OUTCOME MEASURES: Hepatitis C virus infection
      status of children
      born to
      hepatitis C virus infected women.

      RESULTS: A total of 1,474 hepatitis C virus infected
      women were
      identified,
      of whom 503 (35%) were co-infected with HIV.
      Co-infected women were
      more than
      twice as likely to transmit hepatitis C virus to their
      children than
      women
      with hepatitis C virus infection alone. Overall 9.2%
      (136/1,474) of
      children
      were hepatitis C virus infected. Among the women with
      hepatitis C virus
      infection-only, multivariate analyses did not show a
      significant effect
      of
      mode of delivery and breastfeeding: caesarean section
      vs vaginal
      delivery OR
      = 1.17, P = 0.66; breastfed versus non-breastfed OR =
      1.07, P = 0.83.
      However, HIV co-infected women delivered by caesarean
      section were 60%
      less
      likely to have an infected child than those delivered
      vaginally (OR =
      0.36, P
      = 0.01) and those who breastfed were about four times
      more likely to
      infect
      their children than those who did not (OR = 6.41, P =
      0.03). HIV
      infected
      children were three to four times more likely also to
      be hepatitis C
      virus
      infected than children without HIV infection (crude OR
      = 3.76, 95% CI
      1.89-7.41).

      CONCLUSIONS:
      These results do not support a recommendation of
      elective caesarean
      section
      or avoidance of breastfeeding for women with hepatitis
      C virus
      infection
      only, but the case for HIV infected women undergoing
      caesarean section
      delivery and avoiding breastfeeding is strengthened if
      they are also
      hepatitis C virus infected.


      MOTHER TO CHILD TRANSMISSION OF HEPATITIS C VIRUS: A
      CASE-CONTROL STUDY
      OF
      RISK FACTORS.

      Sophie Poiraud, Hosp Tenon, Paris France; Joseph
      Cohen, Hosp Bicetre,
      Kremlin-Bicetre France; Xavier Amiot, Nadia Berkane,
      Antoine Flahault,
      Hosp
      Tenon, Paris France; Elisabeth Dussaix, Hosp
      Paul-Brousse, Villejuif
      France;
      Pauline Jouet, Hosp Tenon, Paris France; Olivier
      Bernard, Hosp Bicetre,
      Kremlin-Bicetre France; Jean-Didier Grange, Hosp
      Tenon, Paris France

      Background : Mother-to-child transmission rate of
      hepatitis C virus
      (HCV) is
      low, less than 10 % in women not co-infected with HIV.
      Because most of
      published studies have included a small number of
      HCV-RNA positive
      children
      (N < 10), the transmission risk factors remain
      unclear. Invasive
      procedures,
      such as amniocentesis or use of forceps, could
      increase the risk of
      transmission. The aim of the study was to evaluate the
      risk factors for
      vertical transmission of HCV, using a case-control
      design. Patients and
      methods: all children born to HCV-RNA positive,
      anti-HIV negative
      mothers
      were included in the study (patient group). Incident
      cases were HCV-RNA
      positive children after one month of age. Controls
      were HCV-RNA
      negative
      after 1 month of age and/or anti-HCV negative
      children. The following
      risk
      factorswere analyzed : amniocentesis, vaginal or
      caesarean-section
      delivery,
      use of forceps, episiotomy, maternal breast-feeding or
      bottle-feeding.
      Results: from January, 1992, to August, 2000, 161
      mother-child pairs
      (51
      cases and 110 controls) were included. The mean mother
      age was 31.2�5.9
      years
      in the patient group compared with 32.6�5.2 years in
      the control group
      (NS).
      Caesarean-section delivery rate was 13 % in the
      patient group and 22.9
      % in
      the control group (p = 0.27). Vaginal delivery rate
      with forceps was
      39.5 %
      in the patient group and 25 % in the control group (p
      = 0.13).
      Episiotomy
      rate was 61 % in the patient group and 57.9 % in the
      control group (p =
      0.83). Amniocentesis rate was 16.6 % in the patient
      group and 25.3 % in
      the
      control group (p=0.27). Breastfeeding rate was 56.2 %
      in the patient
      group
      and 43.4 % in the control group (p = 0.16). Logistic
      regression
      analysis
      showed that vaginal delivery with forceps was the only
      significant and
      independent factor associated with vertical
      transmission (OR = 3.24,
      95% CI
      [1.03;10.10], p=0.04). We performed a secondary
      analysis for all
      variables
      limited to the 123 children of different mothers. The
      estimation of the
      OR
      related to the way of delivery was very close in this
      secondary
      analysis.
      Conclusions: our study demonstrates an increased HCV
      vertical
      transmission
      risk during vaginal delivery with use of forceps
      compared with
      caesarean-section delivery. Episiotomy does not appear
      as a risk factor
      during vaginal delivery. Maternal breast-feeding was
      not found to be a
      risk
      factor (nevertheless, we cannot exclude a risk with a
      ratio lower than
      3).
      Furthermore, amniocentesis does not increase the risk
      of
      mother-to-child
      transmission of HCV.

      __________________________________________________
      Do You Yahoo!?
      Make international calls for as low as $.04/minute with Yahoo! Messenger
      http://phonecard.yahoo.com/
    Your message has been successfully submitted and would be delivered to recipients shortly.