A significant sex--but not elective cesarean section--effect on mother-to-child transmission of hepatitis C virus infection.
BACKGROUND
Risk factors for mother-to-child transmission of hepatitis C virus (HCV) are poorly quantified.


METHODS
We conducted a European multicenter prospective study of HCV-infected pregnant women and their infants. Children with > or =2 positive HCV RNA polymerase chain reaction test results and/or anti-HCV antibodies after 18 months of age were considered to be infected.


RESULTS
The overall HCV vertical transmission rate was 6.2% (95% confidence interval [CI], 5.0%-7.5%; 91/1479). Girls were twice as likely to be infected as boys (adjusted odds ratio [OR], 2.07 [95% CI, 1.23-3.48]; P=.006). There was no protective effect of elective cesarean section (CS) delivery on HCV vertical transmission (adjusted OR, 1.46 [95% CI, 0.86-2.48]; P=.16). HCV/human immunodeficiency virus-coinfected women more frequently transmitted HCV than did women with HCV infection only, although the difference was not statistically significant (adjusted OR, 1.82 [95% CI, 0.94-3.52]; P=.08). Maternal history of injection drug use, prematurity, and breast-feeding were not significantly associated with transmission. Transmission occurred more frequently from viremic women, but it also occurred from a few nonviremic women.


CONCLUSIONS
Our results strongly suggest that women should neither be offered an elective CS nor be discouraged from breast-feeding on the basis of HCV infection alone. The sex association is an intriguing finding that probably reflects biological differences in susceptibility or response to infection.
D000328:Adult; D002585:Cesarean Section; D016001:Confidence Intervals; D036861:Delivery, Obstetric; D017558:Elective Surgical Procedures; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000150:complications; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000821:virology*; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors