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Risk factors for mother‐to‐child transmission of hepatitis C virus: Maternal high viral load and fetal exposure in the birth canal
Author(s) -
Murakami Jun,
Nagata Ikuo,
Iitsuka Toshiyuki,
Okamoto Manabu,
Kaji Shunsaku,
Hoshika Tadataka,
Matsuda Ryu,
Kanzaki Susumu,
Shiraki Kazuo,
Suyama Akihiko,
Hino Shigeo
Publication year - 2012
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/j.1872-034x.2012.00968.x
Subject(s) - fetus , transmission (telecommunications) , viral load , medicine , viral hepatitis , obstetrics , hepatitis a virus , birth canal , virology , pregnancy , virus , biology , genetics , electrical engineering , engineering
Aim: Mother‐to‐child transmission (MTCT) is the major transmission pathway of hepatitis C virus (HCV) in children. However, its risk factors remain unsettled for introduction of putative intervention. Methods: Pregnant women screened for HCV and MTCT in children born to antibody‐positive mothers were prospectively studied in Tottori, Japan. Results: Among 41 856 screened women, 188 (0.45%) were HCV antibody‐positive, of whom 61% had detectable HCV RNA. While 10 of the 34 children (29%) born to high viral load (HVL: ≥6.0 × 10 5 IU/mL) mothers were infected, none born to RNA‐detectable but non‐HVL mothers were infected ( P < 0.001). MTCT among vaginally delivered children born to HVL mothers was analyzed. Children delivered after 4 h or more of labor were more frequently infected than were those born within 4 h of labor ( P = 0.019). Premature rupture of fetal membranes was significantly more common in infected children than in uninfected children ( P < 0.001). Durations of membrane rupture and labor were longer in infected children than in uninfected children ( P = 0.008 and P = 0.040, respectively). Elective cesarean section that eliminates these risk factors, other than HVL, significantly reduced MTCT from nine of 22 (41%) to none of nine children (0%) ( P = 0.032). Conclusion: Our data suggest that contamination of the fetus in the birth canal with infected maternal blood is a major risk factor for HCV MTCT, in addition to maternal HVL. To rationalize intervention by elective cesarean section, the natural history of infected children should be carefully evaluated.