Hepatitis C virus (HCV) infection is reported in 0.05% to 0.36% of children in developed nations.1 Since improved screening of donor blood and blood products began in the 1990s, vertical transmission has become the primary cause of HCV infection in children.1-5 As many as 4,000 new cases of pediatric HCV infection may develop each year in the United States.6
At present, no clear interventions exist to prevent mother-to-child transmission (MTCT) of HCV.4,7 No HCV vaccine is yet available, and most current antiviral therapies are not considered safe for pregnant patients: ribavirin and interferon α, for example, are in pregnancy categories X and C, respectively.3,7 (See “Safer HCV Treatment Options in Pregnancy?”8,9) Some might argue that HCV infection is reported in only 1% to 2% of pregnant women in industrialized countries7 and that the rate of MTCT is low at 2% to 10%.3-5 Nevertheless, researchers maintain that HCV during pregnancy is a “neglected condition” and call for substantial improvements in public health response to affected patients.3,4 Awareness of risk factors for MTCT is essential.
Vertical transmission is believed to be limited to women with detectable viral load,3,4,10 and the risk grows with increasing maternal viremia (ie, HCV RNA > 105 copies/mL1). Risk for MTCT is heightened in women who are coinfected with HIV,3,11 with one systematic review showing a 10.8% vertical transmission risk among coinfected women, versus 5.8% among those with HCV infection alone.2 Transmission risk is increased in mothers with a history of IV drug use or a sexual partner infected with HCV.10 Perinatal procedures that expose the infant to HCV-infected maternal blood (eg, episiotomy, internal fetal monitoring) also elevate MTCT risk.3,7,1011
Safer HCV Treatment Options in Pregnancy?
The recently approved regimen of sofosbuvir/ledipasvir [Harvoni®] has a pregnancy category of B, based on animal studies alone; its manufacturer recommends use of this regimen in pregnant patients only if its potential benefits exceed the potential risk to the fetus.8 Similarly, a pregnancy category of B (again, based only on animal studies) has been assigned to the combination of ombitasvir/paritaprevir/ritonavir with dasabuvir [Viekira Pak™], and its use during pregnancy is recommended “only if clearly needed”; additionally, its coadministration with ribavirin is absolutely contraindicated.9
In an effort to identify strategies to reduce vertical transmission of HCV, researchers for the US Preventive Services Task Force (USPSTF)6 performed a review of studies on the impact of mode of delivery, breastfeeding practices, and other factors on MTCT. No difference in HCV transmission was found in vaginal vs cesarean deliveries; however, in one good-quality study, a higher MTCT rate was found among cases involving prolonged duration of ruptured membranes (> 6 h before delivery).
Continue for association between breastfeeding and HCV >>