title: Vertical transmission of hepatitis C virus in low to middle socio-economic pregnant population of Karachi.
abstract: OBJECTIVE
  To determine the rate of vertical transmission (transmission from mother to child) of hepatitis C virus in low to middle socio-economic pregnant women.
  
  
  METHODS
  This study was conducted at Sarwar Zuberi Liver Centre (SZLC) in collaboration with the department of Gynaecology and Obstetrics, Civil Hospital Karachi (CHK) and Abbasi Shaheed Hospital (ASH) for a period of 4 years from September 2005 to December 2009. Total 18,000 women seeking antenatal care were screened for hepatitis C antibodies (Anti-HCV) using 4th generation ELISA technique. Positive 1,043 women were further offered HCV ribonucleic acid (RNA) by polymerase chain reaction (PCR). Six hundred and forty women agreed to have PCR done, and 510 PCR positive women were finally included in the study, followed till delivery and treated if required. Newborns of 510 PCR positive mothers were advised HCV-RNA by PCR from 3 to 12 months of age and Anti-HCV at 18 up to 24 months and followed up to 3 years.
  
  
  RESULTS
  1,043/18,000 (5.79%) mothers were Anti-HCV positive, of which PCR results of 640 mothers are available where 510/640 (79.7%) were PCR positive, 357/510 (70%) delivered by spontaneous vaginal delivery (SVD), 33 (6.4%) by forceps delivery, 70 (13.7%) had elective, and 50 (9.8%) had emergency caesarian section. Premature rupture of membranes (PROM) was present in 81 mothers. Data of 510 babies from 3 months to 3 years of age was available of which only 215 had their laboratory tests done (HCV-RNA-PCR in 86 and Anti-HCV in 129). Mean birth weight (kg), height (cm) and OFC (cm) were 2.74 ± 0.43, 52.4 ± 7.5, and 35 ± 4. Apgar score median at 1 and 5 min was 7 (range 2-10), 8 (range 4-10), respectively. Low birth weight was present in 49 (9.6%), 37 (7.2%) had history of Neonatal Intensive Care Unit (NICU) admission. PCR of none of the 86 babies done at 3-12 months was positive. Five babies out of 129 were Anti-HCV positive at 18 months of age. Of this, 3/5 was HCV-RNA-PCR positive. Rate of vertical transmission of HCV was 1.39.
  
  
  CONCLUSIONS
  In spite of the high hepatitis C positivity in pregnant population, the rate of vertical transmission to the neonate is low.
authors.affiliation: Sarwar Zuberi Liver Centre, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Sindh, Pakistan, sigma_98@hotmail.com.
authors.forename: Sina
authors.initials: S
authors.lastname: Aziz
authors.forename: Nazli
authors.initials: N
authors.lastname: Hossain
authors.forename: Saadiya Aziz
authors.initials: SA
authors.lastname: Karim
authors.forename: Jamila
authors.initials: J
authors.lastname: Rajper
authors.forename: Nargis
authors.initials: N
authors.lastname: Soomro
authors.forename: Wajeeha
authors.initials: W
authors.lastname: Noorulain
authors.forename: Rana
authors.initials: R
authors.lastname: Qamar
authors.forename: Rafiq
authors.initials: R
authors.lastname: Khanani