title: When does mother to child transmission of hepatitis C virus occur?
abstract: OBJECTIVE
  To investigate when hepatitis C virus (HCV) infection from mother to child occurs, and evaluate possible associated factors.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Fifty four HCV infected children tested within three days of birth and their mothers.
  
  
  METHODS
  HCV RNA polymerase chain reaction (PCR) results.
  
  
  RESULTS
  Seventeen of the children (31%, 95% confidence interval 19% to 46%) were positive in the first 3 days of life and could be assumed to have acquired infection in utero. Testing PCR positive was not associated with sex (53% v 49% boys; p=0.77) or mode of delivery (29% elective caesarean section in both groups; p=0.98). Children with evidence of intrauterine infection were significantly more likely to be of lower birth weight and infected with genotype 1 (58% v 12%, p=0.01). Although a higher proportion of infants born to HCV/HIV co-infected women were PCR positive in the first 3 days of life, this difference did not reach statistical significance; excluding infants born to co-infected women did not affect the results. Thirty seven of the children (68%) were negative in the first 3 days of life, 27 of whom were positive when tested again at 3 months, and nine were first PCR positive after 3 months (one child had no further tests).
  
  
  CONCLUSIONS
  These results suggest that at least one third and up to a half of infected children acquired infection in utero. Although postpartum transmission cannot be excluded, these data suggest that it is rare. The role of HCV genotypes in the timing and mechanism of infection should be explored further.
authors.affiliation: Paediatric HIV Service, Royal Hospital for Sick Children, Edinburgh, Scotland, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mok
authors.forename: L
authors.initials: L
authors.lastname: Pembrey
authors.forename: P-A
authors.initials: PA
authors.lastname: Tovo
authors.forename: M-L
authors.initials: ML
authors.lastname: Newell
mesh_terms: D001942:Breast Feeding; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000821:virology; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000235:genetics / Q000635:transmission*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D012367:RNA, Viral
references.citation: Pediatr Infect Dis J. 2000 Jun;19(6):511-6
references.pmid: 10877164
references.citation: Intervirology. 1998;41(4-5):208-12
references.pmid: 10213898
references.citation: Lancet. 2000 Sep 9;356(9233):904-7
references.pmid: 11036896
references.citation: J Med Virol. 2002 Jun;67(2):137-42
references.pmid: 11992574
references.citation: J Infect Dis. 2003 Feb 1;187(3):345-51
references.pmid: 12552417
references.citation: J Med Virol. 2003 Feb;69(2):195-201
references.pmid: 12683407
references.citation: AIDS. 2003 Jul 4;17(10):1493-501
references.pmid: 12824787
references.citation: N Engl J Med. 1992 Oct 22;327(17):1246-7
references.pmid: 1406816
references.citation: J Virol. 1993 Jul;67(7):4365-8
references.pmid: 8389933
references.citation: J Pediatr. 1995 Apr;126(4):589-91
references.pmid: 7535353
references.citation: J Pediatr. 1995 Aug;127(2):278-80
references.pmid: 7636656
references.citation: AIDS. 1995 Sep;9(9):F7-11
references.pmid: 8527070
references.citation: Clin Infect Dis. 1997 Nov;25(5):1121-4
references.pmid: 9402369
references.citation: J Pediatr. 1998 Jan;132(1):167-9
references.pmid: 9470023
references.citation: Int J Epidemiol. 1998 Feb;27(1):108-17
references.pmid: 9563703
references.citation: J Infect Dis. 1998 Jun;177(6):1480-8
references.pmid: 9607823
references.citation: Pediatrics. 1998 Aug;102(2 Pt 1):355-9
references.pmid: 9685438
references.citation: BMJ. 1998 Aug 15;317(7156):437-41
references.pmid: 9703524
references.citation: J Hepatol. 1998 Aug;29(2):191-7
references.pmid: 9722199
references.citation: AIDS. 2000 Jul 7;14(10):1421-8
references.pmid: 10930158