June 24, 1996
Circulating HCV RNA Does Not Increase Pregnancy
Complications
Hepatitis Weekly via Individual Inc
A substantial proportion of pregnant women with hepatitis C virus
infection have circulating HCV RNA, even when they are
asymptomatic, according to a report from Italy. Researcher A.
Floreani and colleagues noted, however, that these women do not
have an increased risk of obstetric complications and that
pregnancy does not appear to induce symptomatic liver disease.
The influence on hepatitis C virus (HCV) infection on pregnancy
and the influence of pregnancy on HCV-related disease are poorly
understood. During pregnancy increased production of different
hormones and cytokines might influence HCV activity and the
underlying liver disease. On the other hand, HCV infection might
influence the outcome of the pregnancy and affect the fetus. "Many
papers have addressed the problem of mother-to-child HCV
transmission," researcher A. Floreani and colleagues wrote ("HCV
Infection in Pregnancy," British Journal of Obstetrics and
Gynecology, 1996;103:325- 329). "In general, vertical transmission
is only partially understood, due to the lack of convenient and
effective tests to quantify the viremia. Nevertheless, there is
only a limited knowledge of maternal HCV infection." In this study,
Floreani et al. investigated the clinical aspects of HCV infection
during pregnancy and after delivery, and the outcome of pregnancy
in anti-HCV positive women.
The study included 1700 consecutive pregnant women attending an
obstetrics department for high risk pregnancies at the University
of Padova, Italy Health Center.
Each woman underwent serological screening for hepatitis surface
antigen (HBsAg), antibodies to HCV (anti-HCV), antibodies to HIV 1
within the first trimester of pregnancy and clinico-biochemical
assessment in order to ascertain previous or active liver disease
and risk factors for viral infections. Twenty-nine (1.7 percent) of
the 1700 women were found anti-HCV positive. Eight of them had an
associated positivity for HIV infection. HCV RNA was positive in
64.2 percent of anti-HCV positive women. Liver function tests
(including transaminases) were within the normal range in 27
mothers (both during and six months after delivery). Only two of 29
women had a slight increase in AST/ALT; liver biopsy in these cases
was compatible with mild chronic active hepatitis.
In all women, the outcome of pregnancy was favorable (12 of 29
anti-HCV positive mothers underwent cesarean delivery for causes
independent of HCV infection).
"Forty percent of mothers had a cesarean delivery," Floreani et
al. wrote. "This percentage might be higher than expected, but it
reflects a similar rate observed in the same high risk obstetric
department over the last five years. None of the cesarean
deliveries was due to complications directly correlated to HCV
infection.
"There is no risk to the outcome of pregnancy in an anti-HCV
positive pregnant mother. The majority of pregnant women have
normal transaminase levels during the course of pregnancy, although
a substantial proportion have circulating HCV RNA. Pregnancy does
not induce a deterioration of liver disease, and HCV infection does
not increase the risk of obstetric complications." The
corresponding author for this study is A. Floreani, Department of
Gastroenterology, Via Giustiniani 2, 35100 Padova, Italy.
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