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Influence of hepatitis C viral parameters on pregnancy complications and risk of mother-to-child transmission

Kushner T, Djerboua M, Biondi MJ, Feld JJ, Terrault N, Flemming JA. J Hepatol. 2022; May 25 [Epub ahead of print]. DOI:

Background — With the World Health Organization plan for hepatitis C elimination by the year 2030, and recent guideline recommendations to screen all women during pregnancy for HCV, data on HCV in pregnancy are needed to determine the association of HCV viremia with adverse pregnancy outcomes and mother-to-child transmission.

Methods — This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with HCV and pregnancy were identified and further stratified by whether they had active HCV viremia during pregnancy or resolved viremia at time of pregnancy. Peak HCV viral load was determined. Logistic regression was used to determine the association of viremia with adverse pregnancy outcomes; maternal HCV RNA levels were evaluated as a predictor of mother-to-child transmission (MTCT).

Findings — We identified a total of 2,170 pregnancies in 1636 women who were HCV RNA positive prior to pregnancy; 1,780 (82%) pregnancies were RNA+ during pregnancy. Pregnancies with positive HCV RNA were more likely to have preterm delivery (18% vs. 12%, p=0.002), intrahepatic cholestasis of pregnancy (4% vs. <2%, p=0.003), and postpartum hemorrhage (9% vs 5%, p=0.013), and less likely to have gestational diabetes (6% vs. 10%, p=0.008) than those with resolved infection. Only 511 (29%) infants had screening consistent with guidelines after birth; there was an estimated 3.5% risk of MTCT. HCV RNA ≥ 6.0 log10 IU/mL was significantly associated with MTCT (eOR 3.4, p=0.04).

Interpretations — Active HCV viremia among individuals with a history of HCV infection significantly increases adverse pregnancy outcomes. Few infants are screened for MTCT. Higher HCV RNA is associated with increased risk of MTCT.

Lay Summary — Hepatitis C has increased in women of childbearing age and has important implications in women who become pregnant and their infants. We evaluated the effect that hepatitis C has on pregnancy outcomes as well as the rate of hepatitis C transmission to infants in a large database with linked mother-infant records. We found that active hepatitis C during pregnancy increased the risk of pregnancy complications. We also identified very low rates of testing of infants born to mothers with hepatitis C, but found higher rates of hepatitis C transmission to infants in mothers with higher virus levels.