Hepatitis C in injecting drug-using women during and after pregnancy
Article first published online: 25 DEC 2001
Journal of Gastroenterology and Hepatology
Volume 15, Issue 2, pages 175–181, February 2000
How to Cite
Latt, N. C., Spencer, J. D., Beeby, P. J., M, G. W., Saunders, J. B., Collins, E. and Cossart, Y. E. (2000), Hepatitis C in injecting drug-using women during and after pregnancy. Journal of Gastroenterology and Hepatology, 15: 175–181. doi: 10.1046/j.1440-1746.2000.02060.x
- Issue published online: 25 DEC 2001
- Article first published online: 25 DEC 2001
- alanine aminotransferase;
- hepatitis C RNA;
- hepatitis C virus;
- injecting drug use;
Background: A high proportion of female injecting drug users (IDU) have evidence of hepatitis C virus (HCV) infection. We undertook a prospective study of patients attending a clinic for pregnant IDU to determine the impact of pregnancy on the course of HCV infection and whether pregnancy is affected by HCV infection.
Methods: One hundred and thirty-one IDU were recruited and followed up with liver function tests, HCV serology and HCV-RNA tests.
Results: Of 131 patients, 125 had HCV antibodies (anti-HCV positive) at delivery, and of these 62% were HCV-RNA positive. The anti-HCV-negative women were younger and had a shorter duration of drug use than the anti-HCV-positive women. There were no differences between viraemic and non-viraemic women with respect to age, ethnicity, duration of injecting drug use, methadone maintenance dose, hepatitis B exposure or reported high-risk behaviour. Alanine aminotransferase (ALT) levels were higher and the proportion with ALT > 55 IU/L higher in viraemic women. Viraemia persisted in all 55 women who were viraemic at term. Eleven had an ALT flare post-partum that was unrelated to viral load and was clinically unsuspected. Four had concurrent elevated γ-glutamyltranspeptidase and were considered to be drinking alcohol at hazardous levels. Four of 23 women who were HCV-RNA negative at term became positive during follow up.
Conclusions: Pregnancy does not adversely affect the course of hepatitis C. A modest rebound in ALT levels, but not HCV-RNA, occurs after delivery in some viraemic women. This supports the theory that immune mechanisms rather than direct viral cytopathology are involved in hepatocyte injury during HCV infection. Hepatitis C infection did not influence pregnancy complications and outcomes.