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Hepatitis C and pregnancy. Belopolskaya Maria

Hepatitis C and pregnancy. Belopolskaya Maria. Botkin Infectious Diseases Hospital St Petersburg Russia 2012. 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.

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Hepatitis C and pregnancy. Belopolskaya Maria

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  1. Hepatitis C and pregnancy.Belopolskaya Maria Botkin Infectious Diseases Hospital St Petersburg Russia 2012

  2. 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

  3. Incidence HCV per 100 000 population

  4. Prevalence of HCV-antibody Pregnant women have a prevalence of HCV-antibody similar to that at population. In the world theprevalence 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

  5. Mother-to-infant transmission Therate of mother-to-infant transmission is 4% to 7% per pregnancy when HCV viremia is presented.

  6. Hepatic disease in childhood Research Institute of Children's Infections

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

  8. Benefits of total screening • Observation for women with HCV-infection during pregnancy and after delivery. • Observation for childrenborn from mothers with HCV-infection.

  9. HCV diagnosisof pregnant women

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

  11. 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+).

  12. ALT level in RNA HCV-positive women

  13. Routes of HCV transmission • Transplacental transmission in uterus (antenatal transmission) • Transmission during delivery • Postnatal transmission – through breast-feeding or during child-care

  14. 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

  15. According to our data in 2011

  16. 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 comparedwith boys

  17. 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)

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

  19. 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

  20. THANK YOU

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