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June 24, 1996
Circulating HCV RNA Does Not Increase Pregnancy Complications

Hepatitis Weekly via Individual Inc
A substantial proportion of pregnant women with hepatitis C virus infection have circulating HCV RNA, even when they are asymptomatic, according to a report from Italy. Researcher A. Floreani and colleagues noted, however, that these women do not have an increased risk of obstetric complications and that pregnancy does not appear to induce symptomatic liver disease.

The influence on hepatitis C virus (HCV) infection on pregnancy and the influence of pregnancy on HCV-related disease are poorly understood. During pregnancy increased production of different hormones and cytokines might influence HCV activity and the underlying liver disease. On the other hand, HCV infection might influence the outcome of the pregnancy and affect the fetus. "Many papers have addressed the problem of mother-to-child HCV transmission," researcher A. Floreani and colleagues wrote ("HCV Infection in Pregnancy," British Journal of Obstetrics and Gynecology, 1996;103:325- 329). "In general, vertical transmission is only partially understood, due to the lack of convenient and effective tests to quantify the viremia. Nevertheless, there is only a limited knowledge of maternal HCV infection." In this study, Floreani et al. investigated the clinical aspects of HCV infection during pregnancy and after delivery, and the outcome of pregnancy in anti-HCV positive women.

The study included 1700 consecutive pregnant women attending an obstetrics department for high risk pregnancies at the University of Padova, Italy Health Center.

Each woman underwent serological screening for hepatitis surface antigen (HBsAg), antibodies to HCV (anti-HCV), antibodies to HIV 1 within the first trimester of pregnancy and clinico-biochemical assessment in order to ascertain previous or active liver disease and risk factors for viral infections. Twenty-nine (1.7 percent) of the 1700 women were found anti-HCV positive. Eight of them had an associated positivity for HIV infection. HCV RNA was positive in 64.2 percent of anti-HCV positive women. Liver function tests (including transaminases) were within the normal range in 27 mothers (both during and six months after delivery). Only two of 29 women had a slight increase in AST/ALT; liver biopsy in these cases was compatible with mild chronic active hepatitis.

In all women, the outcome of pregnancy was favorable (12 of 29 anti-HCV positive mothers underwent cesarean delivery for causes independent of HCV infection).

"Forty percent of mothers had a cesarean delivery," Floreani et al. wrote. "This percentage might be higher than expected, but it reflects a similar rate observed in the same high risk obstetric department over the last five years. None of the cesarean deliveries was due to complications directly correlated to HCV infection.

"There is no risk to the outcome of pregnancy in an anti-HCV positive pregnant mother. The majority of pregnant women have normal transaminase levels during the course of pregnancy, although a substantial proportion have circulating HCV RNA. Pregnancy does not induce a deterioration of liver disease, and HCV infection does not increase the risk of obstetric complications." The corresponding author for this study is A. Floreani, Department of Gastroenterology, Via Giustiniani 2, 35100 Padova, Italy.

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