Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus

Objective To investigate the effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. Design Pooled retrospective analysis of prospectively collected data. Sample Data on hepatitis C virus seropositive mothers and their children id entified around delivery were sent from 24 centres of the European Paediatr ic Hepatitis C Virus Network. Main outcome measures Hepatitis C virus infection status of children born t o hepatitis C virus infected women. Results A total of 1,474 hepatitis C virus infected women were identified, of whom 503 (35%) were co-infected with HIV. Go-infected women were more th an twice as likely to transmit hepatitis C virus to their children than wom en with hepatitis C virus infection alone. Overall 9.2% (136/1474) of child ren were hepatitis C virus infected. Among the women with hepatitis C virus infection-only, multivariate analyses did not show a significant effect of mode of delivery and breastfeeding: caesarean section is vaginal delivery OR = 1.17: p = 0.661 breastfed versus non-breastfed OR = 1.07, P = 0.83. Ho wever, HIV co-infected women delivered by caesarean section were 60% less l ikely to have an infected child than those delivered vaginally (OR 0.36, p = 0.01) and those who breastfed were about four times more likely to infect their children than those who did not (OR = 6.41, P = 0.03). HIV infected children were three to four times more likely also to be hepatitis C virus infected than children without HIV infection (crude OR = 3.76, 95% CI 1.89- 7.41). Conclusions These results do not support a recommendation of elective caesa rean section or avoidance of breastfeeding for women with hepatitis C virus infection only, but the case for HIV infected women under,going caesarean section delivery and avoiding breastfeeding is strengthened if they are als o hepatitis C virus infected.