Author:
Holzmann, M, et al; J Infect Dis. 2003:187:345-351
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Date Posted: Sun, August 10 2003, 7:49:18 PDT
In reply to:
Pediatr Infect Dis J 2001;20:10-14.
's message, "HCV Viremia at Delivery a Risk Factor for Mother-to-Infant" on Sat, March 03 2001, 15:45:53 PST
Vaginal laceration is a risk factor for HCV transmission in childbirth
Vaginal delivery itself did not increase the risk for transmission.
July 2003VIENNA, Austria - Children delivered vaginally and whose mothers
sustained a perineal or vaginal laceration had a six-fold higher risk of
hepatitis C virus (HCV) than vaginally delivered children whose mothers had
no laceration, according to a retrospective study of 73 HCV-positive
pregnant women who gave birth to 75 children. "In our study, vaginal
delivery itself did not increase the risk for transmission, compared with
cesarean section," said Heidemarie Holzmann, MD, an associate professor of
virology here at the Institute of Virology, University of Vienna. "But we
were surprised to find a correlation between vaginal lacerations and
transmission of HCV. We suspect these children had a longer exposure to
blood because the duration of the birth was slightly longer."In the study,
82% of HCV-positive mothers were HCV-RNA positive during pregnancy, and 10%
were coinfected with HIV. Nine children had HCV, one had HIV, but no child
was HIV-HCV coinfected. "Except for one HIV-HCV coinfected woman, none of
the 23 mothers who had a cesarean section transmitted HCV to her offspring,"
she said. Among vaginal deliveries, the mean HCV load of mothers who
transmitted HCV to their infants was higher than those who did not (8.1 ×
105 vs. 1.4 × 104 copies/ml; P=.056). Furthermore, a reduction in umbilical
cord blood pH (relative risk, 3.9; P=.04) or the occurrence of perineal or
vaginal laceration (relative risk, 6.4; P=.028) during vaginal delivery
significantly increased the risk of vertical HCV transmission. In mothers
with HIV-HCV coinfection, no increased risk for mother-to-infant
transmission of HCV was observed, although the number investigated was
small.
The study, which recently appeared in the Journal of Infectious Disease,
stated that it would be premature to recommend routine cesarean section for
HCV-positive women. However, "elective cesarean section may reduce the risk
of vertical transmission of HCV among mothers with high HCV viremia,"
Holzmann said. To date, only a few risk factors influencing vertical HCV
transmission have been identified. These are HIV coinfection and the
presence of HCV RNA in maternal blood. "It is still controversial whether
high maternal virus load also poses a higher risk for transmission,"
Holzmann said. Moreover, "the timing of perinatal transmission is uncertain,
and understanding of the obstetrical factors that influence vertical
transmission of HCV is still limited.""High viremia was not a statistically
significant risk factor for transmission, nor was vaginal delivery itself,"
she said. "But we found that perinatal infantile hypoxia and vaginal or
perineal laceration that occurred during vaginal delivery significantly
increased the risk for HCV transmission," she saidClinical data on
HCV-positive mothers were assessed by questionnaires sent to mothers and
their gynecologists following delivery and by review of case histories and
obstetric notes. "HCV was reported to have been acquired through injecting
drug use in 41 of women (56%) and from infected blood or blood products in
six (8%)," Holzmann said. Other or unknown routes of acquisition were
reported in 26 (36%) of the women.Of the seven mothers who were
HIV-coinfected, one transmitted HCV to her offspring and one transmitted
HIV, but none transmitted both viruses to her child. The HIV-positive child
was delivered vaginally, whereas five children (including the HCV-positive
one) were delivered by elective cesarean section. For the remaining child,
the mode of delivery was unknown. The mothers of positive HCV children had a
higher mean HCV load compared with mothers of uninfected children (7.3 × 105
vs. 2.5 × 104 copies/ml). "But no statistically significant association
could be found between maternal HCV-RNA level and the risk of
mother-to-infant transmission of HCV. However, there was a trend toward a
higher risk of transmission with increasing levels of maternal viremia,"
Holzmann said. In mothers with HIV-HCV coinfection, no increased risk for
mother-to-infant transmission of HCV was observed, although the number
investigated was small. Two other factors that had no apparent impact on
transmission rates were birth weight of the newborn and gestational age. On
the other hand, every reduction in umbilical cord blood pH by 0.1 increased
the risk of mother-to-infant transmission of HCV by four-fold (assuming a pH
standard value of 7.27).
For more information: · Steininger C, Kundi M, Jatzko G, et al. Increased
risk of mother-to-infant transmission of hepatitis C virus by intrapartum
infantile exposure to maternal blood.
J Infect Dis. 2003:187:345-351.
www.hcop.org
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