Division of Liver Diseases, Icahn School of Medicine, New York, NY USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine, New York, NY USA.
ICES, Queen's University, Kingston, Ontario, Canada.
J Hepatol. 2022 Nov;77(5):1256-1264. doi: 10.1016/j.jhep.2022.05.016. Epub 2022 May 26.
BACKGROUND & AIMS: 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 (MTCT).
This retrospective cohort study was performed in Ontario, Canada, using population-based administrative healthcare data. Individuals were stratified based on 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 MTCT.
We identified a total of 2,170 pregnancies in 1,636 women who were HCV RNA positive prior to pregnancy; 1,780 (82%) pregnancies occurred in women who were HCV RNA positive during pregnancy. Patients who were HCV RNA positive during pregnancy were more likely to have preterm delivery (18% vs. 12%, p = 0.002), intrahepatic cholestasis of pregnancy (4% vs. <2%, p = 0.003), and post-partum 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 log IU/ml was significantly associated with MTCT (exact odds ratio 3.4, p = 0.04).
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.
The prevalence of hepatitis C has increased in women of child-bearing age and has important implications for 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.
随着世界卫生组织（WHO）计划在 2030 年消除丙型肝炎，以及最近的指南建议在所有孕妇怀孕期间筛查丙型肝炎病毒（HCV），需要获得有关妊娠期间 HCV 的数据，以确定 HCV 病毒血症与不良妊娠结局和母婴传播（MTCT）之间的关联。
本回顾性队列研究在加拿大安大略省进行，使用基于人群的医疗保健管理数据。根据她们在怀孕期间是否存在活跃的 HCV 病毒血症或在怀孕期间病毒血症是否已得到解决，将个体分层。确定 HCV 病毒载量峰值。使用逻辑回归确定病毒血症与不良妊娠结局的关联；评估母体 HCV RNA 水平作为 MTCT 的预测指标。
我们共在 1636 名 HCV RNA 阳性的孕妇中确定了 2170 例妊娠，其中 1780 例（82%）妊娠发生在怀孕期间 HCV RNA 阳性的孕妇中。怀孕期间 HCV RNA 阳性的患者更有可能早产（18%比 12%，p=0.002）、妊娠肝内胆汁淤积症（4%比 <2%，p=0.003）和产后出血（9%比 5%，p=0.013），而发生妊娠期糖尿病的可能性较低（6%比 10%，p=0.008）。只有 511 例（29%）婴儿在出生后进行了符合指南的筛查；估计有 3.5%的 MTCT 风险。HCV RNA≥6.0 log IU/ml 与 MTCT 显著相关（确切优势比 3.4，p=0.04）。
患有 HCV 感染史的个体的活跃 HCV 病毒血症显著增加了不良妊娠结局的风险。很少有婴儿接受 MTCT 的筛查。较高的 HCV RNA 与 MTCT 风险增加相关。
育龄妇女丙型肝炎的患病率有所增加，这对怀孕的妇女及其婴儿有重要影响。我们在一个具有母婴关联记录的大型数据库中评估了丙型肝炎对妊娠结局的影响以及丙型肝炎向婴儿传播的比率。我们发现，妊娠期间的活跃性丙型肝炎增加了妊娠并发症的风险。我们还发现，对丙型肝炎母亲所生婴儿进行检测的比率非常低，但发现母亲病毒水平较高的婴儿丙型肝炎传播率较高。
