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Influence of hepatitis C viral parameters on pregnancy
complications and risk of mother-to-child transmission
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May 16 2022
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Establishing a Protocol for Management and DAA Treatment of HCV during Pregnancy: Adherence to a Co-Located Care Protocol - (02/05/22)
We uniquely demonstrate that active viremia during pregnancy increases the risk of adverse outcomes
We found that active hepatitis C during pregnancy increased the risk of pregnancy complications. We also identified very low rates of testing of infants born to mothers with hepatitis C, but found higher rates of hepatitis C transmission to infants in mothers with higher virus levels.
In a large Canadian population-based cohort of pregnancies in women with a history of HCV infection and linked maternal-infant data, women who remained HCV viremic during pregnancy had increased odds of adverse perinatal outcomes compared to women with cleared HCV infection prior to pregnancy after adjusting for important confounders. HCV RNA level of >6 log10 IU/mL was associated with an almost 4-fold higher risk of MTCT. Our findings suggest that not only does clearance of HCV eliminate the risk of perinatal transmission, but it may also reduce the risk of pregnancy complications.
Our study also demonstrates a potential HCV RNA viral load cutoff which is associated with an increased risk of MTCT, a critical knowledge gap for counseling women with HCV during pregnancy. We suggest that aiming to achieve an HCV RNA < 3.5 log10 IU/mL (below which we saw no MTCT events) during pregnancy may be a target to reduce risk of MTCT.
Our study, like other cohorts, demonstrated that screening for HCV among infants born to mothers was inadequate. Less than 30% had HCV screening as recommended by guidelines, and patterns of screening were heterogeneous. There were few infants who had testing after 18 months of age and given data on sensitivity and specificity of earlier HCV RNA testing for MTCT,(
[25]) this may point to the potential benefit to screen earlier with HCV RNA.
Pregnancy outcome of anti-HCV direct-acting antivirals: Real-life data from an Egyptian cohort - (11/06/21)
Hepatitis C in Women & During Pregnancy: Challenges and Implications
CROI: Universal hepatitis C virus screening in pregnancy HCV Testing Quadruples With Switch to Universal Screening in Pregnancy - (02/16/22)
webinar-HCV in Women & During Pregnancy: Challenges and Implications
Click to View Webinar: Friday, Dec 03rd, 2021 1:30
Speaker: Tatyana Kushner, MD, MSCE Assistant Professor of Medicine
Division of Liver Diseases
Icahn School of Medicine at Mount Sinai
Download the Tatyana Kushner, MD, MSCE
Slide Set Here 12/03
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Influence of hepatitis C viral parameters on pregnancy complications and risk of mother-to-child transmission
Jnl of Hepatology May 16 2022 Tatyana Kushner, MD, MSCE, Maya Djerboua, Mia J. Biondi, PhD, Jordan J. Feld, MD, Norah Terrault, MD, Jennifer A. Fl
Highlights
• HCV viremia was independently associated with adverse pregnancy outcomes including intrahepatic cholestasis of pregnancy and postpartum hemorrhage
• Few infants received appropriate testing to evaluate for perinatal transmission
• Mother-to-child transmission of hepatitis C was estimated to be 3.5% among those infants tested
• HCV RNA ≥ 6 log10 IU/mL was significantly associated with MTCT
Abstract
Background
With the World Health Organization plan for hepatitis C elimination by the year 2030, and recent guideline recommendations to screen all women during pregnancy for HCV, data on HCV in pregnancy are needed to determine the association of HCV viremia with adverse pregnancy outcomes and mother-to-child transmission.
Methods
This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with HCV and pregnancy were identified and further stratified by whether they had active HCV viremia during pregnancy or resolved viremia at time of pregnancy. Peak HCV viral load was determined. Logistic regression was used to determine the association of viremia with adverse pregnancy outcomes; maternal HCV RNA levels were evaluated as a predictor of mother-to-child transmission (MTCT).
Findings
We identified a total of 2,170 pregnancies in 1636 women who were HCV RNA positive prior to pregnancy; 1,780 (82%) pregnancies were RNA+ during pregnancy. Pregnancies with positive HCV RNA were more likely to have preterm delivery (18% vs. 12%, p=0.002), intrahepatic cholestasis of pregnancy (4% vs. <2%, p=0.003), and postpartum hemorrhage (9% vs 5%, p=0.013), and less likely to have gestational diabetes (6% vs. 10%, p=0.008) than those with resolved infection. Only 511 (29%) infants had screening consistent with guidelines after birth; there was an estimated 3.5% risk of MTCT. HCV RNA ≥ 6.0 log10 IU/mL was significantly associated with MTCT (eOR 3.4, p=0.04).
Interpretations
Active HCV viremia among individuals with a history of HCV infection significantly increases adverse pregnancy outcomes. Few infants are screened for MTCT. Higher HCV RNA is associated with increased risk of MTCT.
Lay summary
Hepatitis C has increased in women of childbearing age and has important implications in women who become pregnant and their infants. We evaluated the effect that hepatitis C has on pregnancy outcomes as well as the rate of hepatitis C transmission to infants in a large database with linked mother-infant records. We found that active hepatitis C during pregnancy increased the risk of pregnancy complications. We also identified very low rates of testing of infants born to mothers with hepatitis C, but found higher rates of hepatitis C transmission to infants in mothers with higher virus levels.
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