Hepatitis C infection in pregnancy and risk of vertical transmission

Infection with HCV does not negatively affect fertility and the association of HCV infection and pregnancy can be encountered in medical practice. Most women infected with HCV may expect an undisturbed pregnancy course when their liver disease is mild or moderate, but advanced liver damage requires intensive obstetrical care to limit both maternal and foetal consequences. HCV is transmitted to the child in approximately 5% of cases and coinfection with HIV can increase the rate of HCV transmission. Infected infants generally progress to chronic disease with a benign course, at least in the short term, but the long-term natural history of such infections is poorly understood. HCV RNA in maternal blood is the main risk factor for transmission. High viral loads correlate with increased risk of transmission but a specific cut-off value which predicts infection cannot be defined. There is no specific HCV genotype which is preferentially transmitted. No firm evidence is available that children born by caesarean section have a lower risk of infection compared to those born vaginally. The impact on transmission of obstetrical variables such as invasive procedures, length of membrane rupture, caesarean section performed before or during labour or operative delivery require further investigation. There is no evidence of an association between breastfeeding and an increased risk of perinatal HCV infection. In absence of safe and effective drugs to treat maternal infection and of interventions to prevent vertical transmission, routine HCV screening is currently not recommended in pregnant women.