Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy

Background. Reports of obstetric complications of mothers infected with hep atitis C virus (HCV) are limited and the risk of mother-to-infant transmiss ion varies widely. We assessed the course of pregnancy in HCV-infected wome n and the rate of vertical transmission. Methods. Between October 1992 and December 1996, 3712 pregnant patients of the university hospital Grosshadern Munich, Germany, were screened for anti -HCV and analyzed for HCV-RNA by polymerase chain reaction. Clinical and bi ochemical parameters were monitored. Children born to HCV-positive women we re followed up at 6, 12 and 18 month intervals and screened for anti-HCV an d HCV-RNA. Results. Thirteen (42%) of 31 anti-HCV positive patients had a cesarean sec tion which was twice the rate of that in the HCV-negative group (p=0.004). None of the cesarean deliveries was due to complications directly caused by HCV infection. Nine (29%) of 31 anti-HCV positive women had preterm delive ry compared to 19% in the anti-HCV negative patients, the difference being statistically not significant. Fetal outcome parameters such as APGAR score , umbilical pH and birth weight of HCV infected pregnancies were not impair ed. All 29 babies tested for anti-HCV were seropositive after birth. Betwee n 12 and 18 months of age, 10% of the infants still were anti-HCV positive, whereas only one baby was HCV-RNA positive beyond 12 months yielding a ver tical transmission rate of 5% among HCV-RNA positive mothers. Conclusion. Anti-HCV positive pregnancies have an increased risk of cesarea n delivery, probably due to the high-risk collective of anti-HCV positive m others. The mother-to-child transmission rate is low and linked to maternal HCV-RNA positivity.