|
Chronic
Hepatitis C During Pregnancy
Posted
02/10/2003
http://www.medscape.com/
Question
In
a pregnant patient with chronic hepatitis C, will a scheduled
cesarean section reduce the risk of vertical transmission? Is
there a place for the use of pegylated interferon during the
third trimester to reduce viral load?
Response
from Emmet B. Keeffe, MD, 02/10/2003
It
is well recognized that there is a small risk of vertical
transmission of hepatitis C virus (Hepatitis C Virus) from a pregnant woman
to her newborn child.[1]
Approximately 60% to 70% of pregnant women who are anti-Hepatitis C Virus-antibody-positive
will have detectable serum Hepatitis C Virus RNA. The risk of
maternal-infant transmission ranges from 4% to 7% in women who
are viremic, with some evidence that transmission may be more
likely if the viral load is > 106 copies/mL.
Although
reports have been mixed, there is generally no difference in
the rate of maternal-infant transmission with vaginal delivery
compared with elective cesarean section. In one of the largest
analyses of vertical transmission of Hepatitis C Virus, Conte and colleagues[2] showed that transmission was not related to the type of
delivery. Data from this study and other investigations were
reviewed at the recent National Institute of Health Consensus
Development Conference on the Management of Hepatitis C by
Roberts and Yeung,[1]
who affirmed that the consensus from published studies is that
the rate of Hepatitis C Virus transmission from the pregnant woman to her
newborn child is not influenced by the method of delivery (ie,
elective cesarean section vs usual vaginal delivery). The
weighted rate of transmission was 4.3% for vaginal delivery
and 3.0% for cesarean section.
Even
though some evidence shows that transmission of Hepatitis C Virus to the
newborn may be more likely if serum Hepatitis C Virus RNA levels are > 106 copies/mL, these studies are not conclusive and
antiviral therapy is not thought to be safe during pregnancy.
Ribavirin is contraindicated based on its risk of
teratogenicity, and interferon (either interferon alfa or
pegylated interferon) is generally regarded as contraindicated
in pregnancy.
References
- Roberts EA, Yeung L. Maternal-infant transmission
of hepatitis C infection. Hepatology.
2002;36(suppl):S106-S113.
- Conte D, Fraquelli M, Prati D, Colucci A, Minola
E. Prevalence and clinical course of chronic hepatitis C
virus (Hepatitis C Virus) infection and rate of Hepatitis C Virus vertical
transmission in a cohort of 15,250 pregnant women.
Hepatology. 2000;31:751-755.
About the Panel Members
Emmet Keeffe, MD, Professor of Medicine, Department of
Internal Medicine, Stanford University, Stanford, California;
Chief of Hepatology and Co-Director of Liver Transplant
Program, Department of Gastroenterology, Stanford University
Medical Center, Stanford, California; Chair, DDW Council, 2000
- Present
|
