title: Obstetrical and neonatal outcomes among women infected with hepatitis C and their infants.
abstract: OBJECTIVE
  (1) To describe obstetrical and neonatal outcomes among a cohort of hepatitis C virus (HCV) infected women, comparing HCV RNA positive to HCV RNA negative women; (2) to characterize virologic and hepatic parameters associated with HCV infection during pregnancy; and (3) to describe the rate of HCV vertical transmission.
  
  
  METHODS
  We prospectively enrolled 145 HCV-positive pregnant women across British Columbia between 2000 and 2003. Participating women were monitored during pregnancy and their infants were followed to assess them for HCV infection. Maternal HCV RNA was assessed close to delivery.
  
  
  RESULTS
  Seventy percent of women reported injection drug use as their primary risk factor for HCV acquisition. Observed rates of intrauterine fetal death, preterm delivery, small for gestational age, and low birth weight infants were 3.4%, 17.9%, 11.3%, and 12.5%, respectively, without a significant association with maternal HCV RNA status. The rate of cholestasis was 5.6% in the HCV RNA-positive group (6/108) and 2.8% in the HCV RNA-negative group (1/37) (P = 0.496). Serum alanine aminotransferase levels decreased significantly through pregnancy, and were significantly higher in HCV RNA-positive women than in HCV RNA-negative women after controlling for cholestasis, co-infections, and alcohol consumption. Among the HCV RNA-positive women, the median FIB-4 score was 0.67 (IQR 0.56 to 0.76) in the first trimester, 0.74 (IQR 0.52 to 1.18) in the second trimester, and 0.89 (IQR 0.52 to 1.09) in the third trimester (P = 0.02). The median HCV viral load at delivery was 424 561 IU/mL. The vertical transmission rate was 4.7% in HCV RNA-positive women, with no cases in HCV RNA-negative women.
  
  
  CONCLUSIONS
  Because of the high rates of poor obstetrical outcomes found in this prospective cohort, population-level screening for HCV in pregnancy should be considered.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Women's Health Research Institute, Vancouver BC.
authors.forename: Deborah
authors.initials: D
authors.lastname: Money
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Women's Health Research Institute, Vancouver BC.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boucoiran
authors.affiliation: Women's Health Research Institute, Vancouver BC.
authors.forename: Emily
authors.initials: E
authors.lastname: Wagner
authors.affiliation: Department of Pediatric Infectious Diseases, British Columbia Children's Hospital, Vancouver BC.
authors.forename: Simon
authors.initials: S
authors.lastname: Dobson
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Aaron
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Women's Health Research Institute, Vancouver BC.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Lohn
authors.affiliation: British Columbia Centre for Disease Control, Vancouver BC.
authors.forename: Mel
authors.initials: M
authors.lastname: Krajden
authors.affiliation: Division of Gastroenterology, University of British Columbia, Vancouver BC.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D046689:Fetal Mortality; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D008403:Mass Screening / Q000458:organization & administration; D020380:Needs Assessment; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012367:RNA, Viral; D012307:Risk Factors
chemical_list: D012367:RNA, Viral
keywords: HCV-RNA; hepatitis C; pregnancy; preterm delivery; small for gestational age