Vertical hepatitis C virus transmission:Main questions and answers

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 behav-iors for blood-transmitted infections. Here we review clinical, prognostic and therapeutic aspects of HCV in-fection in pregnant women and their offspring infected through vertical transmission. Pregnancy-related im-mune 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 res-toration 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 immunode-ficiency virus coinfection, prolonged rupture of mem-branes, fetal exposure to maternal infected blood con-sequent to vaginal or perineal lacerations and invasive monitoring of fetus increase the risk of viral transmis-sion. Cesarean delivery and breastfeeding increases the transmission risk in HCV/human immunodeficiency virus coinfected women. The consensus is not to offer antivi-ral therapy to HCV-infected pregnant women because it is based on ribavirin(pregnancy category X) because of its embryocidal and teratogenic effects in animal spe-cies. 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.