Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus
Article first published online: 22 DEC 2003
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 110, Issue 1, page 91, January 2003
How to Cite
Foster, G. R., Tudor-Williams, G., White, J. and Regan, L. (2003), Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. BJOG: An International Journal of Obstetrics & Gynaecology, 110: 91. doi: 10.1046/j.1471-0528.2003.01036_1.x
- Issue published online: 22 DEC 2003
- Article first published online: 22 DEC 2003
We read with interest the meta-analysis confirming that elective caesarean section and avoidance of breastfeeding does not reduce the risks of transmission of chronic hepatitis C. The authors conclude that “these results do not support routine antenatal screening for hepatitis C virus infection”, but they fail to address the other benefits of antenatal testing for hepatitis C. In some areas of Europe, the prevalence of chronic hepatitis C infection in pregnant women is high, typically around 1%1–3. Many infected women do not admit to high risk behaviour when first questioned in the antenatal clinic1,3, and over 70% of women who are infected with hepatitis C have no obvious risk factor at booking. When fewer than one-third of infected women admit to being at risk, a policy of ‘selective screening of those at risk’ is futile. Unless routine screening of all pregnant women is performed, many infected women will not be identified.
If hepatitis C-infected women are not diagnosed, they have a high probability of developing advanced liver disease—30% of patients will develop cirrhosis 30 years after infection4. A small proportion of infected mothers will infect their children and, if these infants are not identified, they have a high probability of developing advanced liver disease during their lifetime. Therapy for chronic hepatitis C now involves interferon plus ribavirin and cures over 50% of those infected5,6. Clearly infected individuals need to be identified before they can be offered the benefits of treatment. Failure to screen women for chronic hepatitis C in pregnancy will lead to early, preventable, maternal death from hepatitis C and a reduced life expectancy in the small number of infected children who are not identified and offered therapy. We believe that in areas where chronic hepatitis C is common, antenatal screening for hepatitis C is a valuable healthcare exercise that identifies infected individuals at a time when they are receptive to healthcare interventions. To ignore the benefits of screening simply because materno-fetal transmission cannot be prevented is unwise and we believe that routine antenatal screening for chronic hepatitis C should be more widely used.
Research into factors that influence materno-fetal transmission of hepatitis C is continuing. It is likely that prospective studies will identify factors that influence the rate of transmission of chronic hepatitis C (e.g. viral load). It will then be appropriate to consider prospective studies to assess the value of caesarean section in women who are at high risk of infecting their infants. We look forward to future developments in this rapidly evolving area.
- 5Peginterferon alfa 2b plus ribavirin compared to interferon alfa 2b plus ribavirin for the treatment of chronic hepatitis C: 24 week treatment analysis of a multicentre, multinational phase III randomized controlled trial. Dallas , USA : AASLD, 2000., , et al.
- 6Pegylated (40 kDa) interferon Alfa-2a (PEGASYS*) in combination with ribavirin: efficacy and safety results from a phase III, randomized, actively-controlled, multicenter study. Atlanta , USA : DDW, 2001., , , et al.