1ST CITY CLINICAL HOSPITAL

The results of scientific research in this area are somewhat contradictory, however, most of them indicate that HCV does not have any negative effect on either the course of pregnancy or the birth of a child. According to the results of a number of observations, during pregnancy in women the level of serum transaminases decreases and the amount of circulating virus decreases. This is probably due to changes in immunological reactivity in pregnant women and an increase in plasma concentrations of female sex hormones (estrogens).

How do you know if the hepatitis C virus has been transmitted from mother to newborn?

During pregnancy and childbirth, antibodies to the hepatitis C virus can pass to the baby through the placenta. As a rule, they circulate in his blood for the first 12–15 (sometimes 18) months, and then disappear.

In order to claim that the mother actually infected the newborn, the following conditions are necessary:

1. antibodies to HCV must circulate in the baby’s blood for more than 18 months from the moment of birth;
2. hepatitis C virus RNA must be detected in the blood of an infant aged 3 to 6 months; moreover, this test must be positive with repeated measurements at least twice
3. the child should have elevated serum transaminases (enzymes that indirectly reflect inflammation of the liver tissue);
4. the genotype of the virus (its variety) must be the same in mother and child

On average, the risk of a child becoming infected from the mother is 1.7% if the mother only has antibodies to HCV. If HCV RNA circulates in the mother's blood serum, the risk of infection of the child is on average 5.6%. This figure varies depending on the geographical area. An example is a clinical study conducted in Italy. It included 2447 pregnant women, 60 of them had antibodies and RNA of the hepatitis C virus. These women infected their children in 13.3% of cases, however, after 2 years of observation, only 3.3% of cases retained RNA of the hepatitis C virus in their children. Thus , the actual infection rate was only 3.3%.

The frequency with which the hepatitis C virus is transmitted from mother to child does not depend on whether the child was born vaginally or the mother had a cesarean section, or whether she had perineal injuries during childbirth or not. The frequency of transmission is also not associated with breastfeeding and does not increase with each subsequent pregnancy.

Breastfeeding is not a risk factor for child infection according to most studies. However, trauma to the mother's nipples and contact with her blood increases this risk, especially in situations where the mother experiences an exacerbation of the disease during the postpartum period. The risk of infection of a child during breastfeeding is currently still being studied.

Most studies (but not all) indicate that with a high viral load in the mother (a large amount of virus circulating in the blood - more than 1 million copies per 1 ml), the child is more likely to become infected. Co-infection with HIV also increases the likelihood of a child becoming infected with HCV. But no connection was found between the mother’s HCV genotype and the child’s infection rate.

When is it necessary to screen for chronic hepatitis in pregnant women?

1. HIV positive women;
2. drug use (past or present);
3. a sexual partner (past or present) who uses or has used intravenous drugs;
4. transfusion of blood or blood substitutes;
5. hemodialysis in the past or present;
6. piercing or tattooing in the past or present;
7. elevated levels of serum transaminases.

The course of hepatitis C in prenatally infected children

Some children have only transient viremia without actual infection. Other children develop an acute, time-limited infection that is virtually asymptomatic with very rapid spontaneous resolution. Sometimes the disease evolves and becomes chronic. Currently, the question of the course of hepatitis C in children remains open to study. It seems that hepatitis C in children does not occur in the same way as in adults and has a more favorable form.

If you are infected with the hepatitis C virus and are planning a pregnancy, consult your doctor. Pregnancy is not contraindicated for you.