Published online Aug 27, 2014. doi: 10.4254/wjh.v6.i8.538
Revised: May 7, 2014
Accepted: June 10, 2014
Published online: August 27, 2014
Hepatitis C virus (HCV) affects about 3% of the world’s population and peaks in subjects aged over 40 years. Its prevalence in pregnant women is low (1%-2%) in most western countries but drastically increases in women in developing countries or with high risk behaviors for blood-transmitted infections. Here we review clinical, prognostic and therapeutic aspects of HCV infection in pregnant women and their offspring infected through vertical transmission. Pregnancy-related immune weakness does not seem to affect the course of acute hepatitis C but can affect the progression of chronic hepatitis C. In fact, postpartum immune restoration can exacerbate hepatic inflammation, thereby worsening the liver disease, particularly in patients with liver cirrhosis. HCV infection increases the risk of gestational diabetes in patients with excessive weight gain, premature rupture of membrane and caesarean delivery. Only 3%-5% of infants born to HCV-positive mothers have been infected by intrauterine or perinatal transmission. Maternal viral load, human immunodeficiency virus coinfection, prolonged rupture of membranes, fetal exposure to maternal infected blood consequent to vaginal or perineal lacerations and invasive monitoring of fetus increase the risk of viral transmission. Cesarean delivery and breastfeeding increases the transmission risk in HCV/human immunodeficiency virus coinfected women. The consensus is not to offer antiviral therapy to HCV-infected pregnant women because it is based on ribavirin (pregnancy category X) because of its embryocidal and teratogenic effects in animal species. In vertically infected children, chronic C hepatitis is often associated with minimal or mild liver disease and progression to liver cirrhosis and hepatocarcinoma is lower than in adults. Infected children may be treated after the second year of life, given the adverse effects of current antiviral agents.
Core tip: Hepatitis C virus (HCV) infection during pregnancy is an emerging problem. While not negatively affecting acute hepatitis, it may exacerbate chronic hepatitis and worsen liver function in woman with liver cirrhosis. HCV does not affect delivery outcome apart from an increased risk of premature membrane rupture and cesarean delivery. The mother-to-child HCV transmission rate is low (3%-5%) and is related to high maternal viremia, human immunodeficiency virus (HIV) coinfection, prolonged rupture of membranes, vaginal lacerations and invasive fetal monitoring. Cesarean delivery and no breastfeeding are indicated for HIV/HCV coinfected women. Antiviral therapy is not routinely offered to pregnant women and infants because of its side effects.