Hepatitis C in pregnancy and mother-to-infant transmission of HCV

Pregnancy is not contraindicated to women infected with HCV and HCV infection does not adversely affect pregnancy. The risk of mother-to-infant transmission of HCV is approximately 5%, but may be higher in children born to mothers with HCV/HIV co-infection. Transmission of infection is usually restricted to mothers who are HCV RNA positive. Higher HCV RNA levels seem to be associated with a greater risk, but a specific cut-off value predicting transmission cannot be defined. Interferon and ribavirin are contraindicated during pregnancy. There is no evidence that caesarean delivery may reduce risk of vertical infection compared to vaginal delivery. Caution should be recommended in using invasive procedures (amniocentesis, villocentesis, funicolocentesis) which may potentially expose the foetus or the neonate to the infected maternal blood. Avoiding foetal scalp monitoring and prolonged labour after rupture of membranes may reduce the risk of vertical transmission of HCV. Breast feeding appears to be safe and is not contraindicated. Infected children usually progress to chronic disease with a benign course, at least initially. Longitudinal studies are needed to determine the long-term natural history of vertical HCV infections. Interferon plus ribavirin combination has been shown to be safe and effective in treating hepatitis C during childhood. Vaccinations against both hepatitis A and hepatitis B are highly recommended to children infected with HCV.