Question In a pregnant patient with chronic hepatitis C, will a scheduled cesarean section reduce the risk of vertical transmission? Is there a place for the use of pegylated interferon during the third trimester to reduce viral load?

Response from Emmet B. Keeffe, MD, 02/10/2003

It is well recognized that there is a small risk of vertical transmission of hepatitis C virus (HCV) from a pregnant woman to her newborn child.[1] Approximately 60% to 70% of pregnant women who are anti-HCV-antibody-positive will have detectable serum HCV RNA. The risk of maternal-infant transmission ranges from 4% to 7% in women who are viremic, with some evidence that transmission may be more likely if the viral load is > 106 copies/mL.

Although reports have been mixed, there is generally no difference in the rate of maternal-infant transmission with vaginal delivery compared with elective cesarean section. In one of the largest analyses of vertical transmission of HCV, Conte and colleagues[2] showed that transmission was not related to the type of delivery. Data from this study and other investigations were reviewed at the recent National Institute of Health Consensus Development Conference on the Management of Hepatitis C by Roberts and Yeung,[1] who affirmed that the consensus from published studies is that the rate of HCV transmission from the pregnant woman to her newborn child is not influenced by the method of delivery (ie, elective cesarean section vs usual vaginal delivery). The weighted rate of transmission was 4.3% for vaginal delivery and 3.0% for cesarean section.

Even though some evidence shows that transmission of HCV to the newborn may be more likely if serum HCV RNA levels are > 106 copies/mL, these studies are not conclusive and antiviral therapy is not thought to be safe during pregnancy. Ribavirin is contraindicated based on its risk of teratogenicity, and interferon (either interferon alfa or pegylated interferon) is generally regarded as contraindicated in pregnancy.

References Roberts EA, Yeung L. Maternal-infant transmission of hepatitis C infection. Hepatology. 2002;36(suppl):S106-S113. Conte D, Fraquelli M, Prati D, Colucci A, Minola E. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology. 2000;31:751-755. Abstract

Emmet Keeffe, MD, Professor of Medicine, Department of Internal Medicine, Stanford University, Stanford, California; Chief of Hepatology and Co-Director of Liver Transplant Program, Department of Gastroenterology, Stanford University Medical Center, Stanford, California; Chair, DDW Council, 2000 - Present