Newly Recognized Factor in Mother-to-Child Transmission of Hepatitis C
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Many women with a chronic viral infection are wary of procreating, because of the chance they may pass their illness on during pregnancy or birth. For those infected with Hepatitis C, this fear is especially pronounced.
There are a handful of reasonable causes supporting a fear of carrying a baby and giving birth with Hepatitis C. They include:
- Hepatitis C is rampant in our society – affecting approximately four million Americans.
- Hepatitis C often leads to chronic liver disease.
- There is currently no guaranteed cure for Hepatitis C.
- Nearly half of those with Hepatitis C are unsure as to how they originally became infected.
Known as vertical transmission, the risk of infants acquiring Hepatitis C from their mother during pregnancy or childbirth is surprisingly low. There have been quite a few studies examining what the likelihood is of vertical transmission and what increases or decreases the risk of infecting a newborn with Hepatitis C.
Although the statistics determining the rate of vertical transmission is not uniform among these studies, experts believe the most accurate estimate of vertical transmission from mothers with Hepatitis C is five percent. Based upon a comprehensive review of trials investigating Hepatitis C vertical transmission, the following appear to represent the two largest risks for bearing a child with Hepatitis C:
- The mother is co-infected with Hepatitis C and HIV.
- The mother has a high Hepatitis C viral load during birth.
In addition, physicians typically relay the following information to pregnant women with Hepatitis C:
- The presence of Hepatitis C infection does not appear to result in a higher risk pregnancy or a higher incidence of poor obstetric outcome.
- Testing for the presence of Hepatitis C in infants born to infected mothers should not begin until at least one year following delivery. The natural history of Hepatitis C infected infants is poorly understood at this time.
- Prophylactic caesarian section is not recommended in Hepatitis C infected mothers. The role of cesarean delivery in mothers co-infected with Hepatitis C and HIV remains controversial.
- Breastfeeding presents a negligible risk of Hepatitis C transmission. Given the well-documented benefits of breastfeeding, it is highly recommended.
It has been a while since there were any additional factors recognized to affect the likelihood of vertical transmission. However, researchers from Italy have recently identified a genetic component that reliably foretells this possibility.
As published in the July 2009 edition of the journal Virology, a mismatch between genes carried by a mother and her infant appear to confer protection against Hepatitis C transmission. Elena Bevilacqua and colleagues from Italy investigated the role of several genes known to play a role in Hepatitis C infection. These researchers found that a specific gene, HLA-DRB1, could predict whether or not the infant acquires Hepatitis C infection from its mother. Based on this research:
- When a mother and child have the same genetic variant of HLA-DRB1, there is no guarantee that vertical transmission will occur; it just increases the likelihood.
- When a mother and child have different variations of HLA-DRB1, there appears to be guaranteed protection from vertical transmission.
Unfortunately, a mother cannot control the similarity or dissimilarity of her infant’s genetic construction. However, whenever a trial reveals a definitive link for Hepatitis C transmission, we gain some ground in understanding this virus. Undoubtedly, the more information gathered on how Hepatitis C is transmitted, infects people, replicates and dies, the closer we are – as a whole – to putting an end to this source of chronic liver disease.
References:
http://en.wikipedia.org/wiki/HLA-DR, HLA-DR, Retrieved September 17, 2009, Wikimedia Foundation Inc., 2009.
http://www.hcvadvocate.org/hcsp/articles/HERRINE.html, Mother-to-Child Transmission of HCV, Steven K. Herrine, MD, Retrieved September 15, 2009, Hepatitis C Support Project, 2009.
http://www.hivandhepatitis.com/hep_c/news/2009/090109_a.html, Genetic Factors Influence Risk of Mother-to-child Hepatitis C Virus Transmission, Retrieved September 15, 2009, hivandhepatitis.com, 2009.
http://www.ncbi.nlm.nih.gov/pubmed/15239255, Diagnostic and prognostic value of virologic tests in vertical transmission of hepatitis C virus infection: results of a large prospective study in pregnant women, Saez, A, et al, Retrieved September 16, 2009, Hepato-Gastroenterology, July-August 2004.
http://www.ncbi.nlm.nih.gov/pubmed/19481774, Genetic factors in mother-to-child transmission of HCV infection, Bevilacqua E, et al, Retrieved September 16, 2009, Virology, July 2009.
