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Multicenter Study
. 2000 Sep 9;356(9233):904-7.
doi: 10.1016/s0140-6736(00)02681-7.

Mother-to-child transmission of hepatitis C virus: evidence for preventable peripartum transmission

D M Gibb  1 , R L Goodall, D T Dunn, M Healy, P Neave, M Cafferkey, K Butler
Affiliations
Multicenter Study

Mother-to-child transmission of hepatitis C virus: evidence for preventable peripartum transmission

D M Gibb et al. Lancet. .

Abstract

Background: Little information is available about the timing of mother-to-child transmission of hepatitis C virus (HCV), and no interventions to decrease transmission rates have been identified. We examined the effect of risk factors, including mode of delivery, on the vertical transmission rate.

Methods: Data from HCV-infected women and their infants from three hospitals in Ireland and from a British Paediatric Surveillance Unit study of infants born to HCV-infected mothers were used to estimate the vertical transmission rate and risk factors for transmission. We used a probabilistic model using methods that simultaneously estimated the time to HCV-antibody loss in uninfected infants and the diagnostic accuracy of PCR tests for HCV RNA.

Findings: 441 mother-child pairs from the UK (227) and Ireland (214) were included. 50% of uninfected children became HCV-antibody negative by 8 months and 95% by 13 months. The estimated specificity of PCR for HCV RNA was 97% (95% CI 96-99) and was unrelated to age; sensitivity was only 22% (7-46) in the first month but rose sharply to 97% (85-100) thereafter. The vertical transmission rate was 6.7% (4.1-10.2) overall, and 3.8 times higher in HIV coinfected (n=22) than in HIV-negative women after adjustment for other factors (p=0.06). No effect of breastfeeding on transmission was observed, although only 59 women breastfed. However, delivery by elective caesarean section before membrane rupture was associated with a lower transmission risk than vaginal or emergency caesarean-section delivery (odds ratio 0 [0-0.87], p=0.04, after adjustment for other factors).

Interpretation: The low sensitivity of HCV RNA soon after birth and the finding of a lower transmission rate after delivery by elective caesarean section suggest that HCV transmission occurs predominantly around the time of delivery. If the findings on elective caesarean section are confirmed in other studies, the case for antenatal HCV testing should be reconsidered.

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Comment in

  • Mother-to-child HCV transmission.
    Fiore S, Newell ML, Pembrey L, Zanetti A, Coll O. Fiore S, et al. Lancet. 2001 Jan 13;357(9250):141-2; author reply 143. doi: 10.1016/S0140-6736(05)71173-9. Lancet. 2001. PMID: 11197417 No abstract available.
  • Mother-to-child HCV transmission.
    Lin HH, Kao JH, Chen DS. Lin HH, et al. Lancet. 2001 Jan 13;357(9250):142-3. doi: 10.1016/S0140-6736(05)71176-4. Lancet. 2001. PMID: 11197419 No abstract available.
  • Mother-to-child HCV transmission.
    Numazaki K, Fujikawa T, Chiba S. Numazaki K, et al. Lancet. 2001 Jan 13;357(9250):142; author reply 143. doi: 10.1016/S0140-6736(05)71174-0. Lancet. 2001. PMID: 11197420 No abstract available.
  • Mother-to-child HCV transmission.
    Hari P, Prasad CG, Lankipalli R. Hari P, et al. Lancet. 2001 Jan 13;357(9250):142; author reply 143. doi: 10.1016/S0140-6736(05)71175-2. Lancet. 2001. PMID: 11197421 No abstract available.

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