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The management of HCV-infected pregnant women
Guillermo Valladares
,
Corresponding author
guibevall@hotmail.com

Correspondence and reprint request:
, Maria H. Sjogren**, Alfonso Chacaltana***
* Past-president of Peruvian Association for Study of Liver Disease.
** Director, Hepatology Research Walter Reed Army Medical Center.
*** Department of Gastroenterology, Centenary Peruvian Japanese Clinic.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0065" class="elsevierStylePara elsevierViewall">Chronic infection with hepatitis C has become a worldwide health problem and is currently one of the most frequent causes of liver transplantation&#46; There is a particular concern regarding the relative immunosuppression during pregnancy&#44; which could theoretically alter the clinical course of the infection&#44; resulting in vertical transmission to the newborn and a possible chronic infection outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Epidemiology</span><p id="p0070" class="elsevierStylePara elsevierViewall">Pregnant women have a prevalence of anti-HCV antibodies similar to that of the general population&#46; Anti-HCV antibodies are detected in 1-2&#37; of people residing in Europe&#44; USA&#44; Taiwan&#44; and Australia&#46; Its frequency is higher in North Africa&#44; where it fluctuates between 15 and 17&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In 75&#37; of pregnant women with detectable anti-HCV antibodies&#44; the HCV RNA is also present in the serum&#44; indicating active infection&#46; The prevalence increases in pregnant women with significant risk factors&#44; in particular intravenous drug addiction and HIV coinfection&#46; In the latter group&#44; the seroprevalence is reported as 17&#46;1-54&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="p0075" class="elsevierStylePara elsevierViewall">In the great majority of women&#44; pregnancy does not seem to affect the clinical course of acute or chronic hepatitis C&#46; In an Irish study of women inadvertently infected with HCV-contaminated immu-noglobulin anti-D&#44; an increase in fetal or obstetrical complications was not observed during a follow-up of 20 years in 100 pregnant women compared with controls&#44; despite the presence of biochemical abnormalities in 55&#37; and hepatic fibrosis in 42&#37; of them&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Nevertheless&#44; a recent study by Pergam found that pregnant women with HCV may have a higher risk of premature rupture of the membrane and that those with excessive weight gain during pregnancy may develop gestational diabetes&#46; In addition&#44; infants born to HCV-infected women are more likely to have low birth weight &#40;&#60; 2&#44;500 g&#41;&#44; be small for the gestational age&#44; be premature &#40;&#60; 37 weeks&#41;&#44; have neonatal jaundice&#44; have a low Apgar score &#40;&#60; 7 at 5 min&#41;&#44; be admitted to a neonatal intensive care unit&#44; and to have a need for assisted ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="p0080" class="elsevierStylePara elsevierViewall">Several studies showed improvement in transami-nases during pregnancy&#46; This may be explained by hemodilution or diminished immunoresponse&#46; In contrast with the decrease in the levels of liver enzymes&#44; an increase in HCV viremia of almost 50&#37; was observed during pregnancy&#44; returning to baseline levels after delivery&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="p0085" class="elsevierStylePara elsevierViewall">Berkley studied a group of HCV-infected pregnant women undergoing methadone treatment for heroin dependency and observed a greater incidence of low-weight microcephalic newborns from these women compared with the HCV-negative pregnant women recruited into the same program&#46; The authors also observed a higher incidence of cholestasis of pregnancy&#44; especially in Hispanic women&#44; which confirmed the findings of previous reports&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="p0090" class="elsevierStylePara elsevierViewall">Conception is infrequent in HCV-cirrhotic women&#59; however&#44; when they become pregnant&#44; these women require special care because of the possibility of decompensation with worsening of portal hypertension &#40;because of increased abdominal pressure and&#47;or plasmatic volume expansion&#41; and secondary coagulopathy&#44; which may produce severe hemorrhage at delivery&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Screening for Hcv in Pregnant Women</span><p id="p0095" class="elsevierStylePara elsevierViewall">HCV screening during pregnancy remains controversial&#46; The fact that about 50&#37; of infected women do not have a clearly defined risk factor argues in favor of this practice&#46; Furthermore&#44; awareness of in fection status may prompt women to modify their life habits&#44; such as limiting alcohol intake or preventing excessive weight gain&#46; The arguments against screening include the fact that there is not an effective therapy for HCV infection during pregnancy&#44; or recommendations to avoid vertical transmission to the newborns&#46; Currently&#44; screening is recommended in high-risk pregnancies or when abnormal transaminase levels are observed <a class="elsevierStyleCrossRef" href="#t0005">&#40;Table 1&#41;</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><elsevierMultimedia ident="t0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Vertical Transmission of Hcv</span><p id="p0100" class="elsevierStylePara elsevierViewall">Many infants born to HCV-infected mothers acquired transplacental immunoglobulin G antibodies passively up to 18 months of life&#44; which renders antibody testing &#40;anti-HCV&#41; of the newborn of little va-lue&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Cord-blood HCV RNA testing can yield false-positive and false-negative results&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Viremia can be found in approximately 70&#37; of vertically infected infants by age one&#59; in addition&#44; 90&#37; will have detectable HCV RNA levels at three months of age&#46; A few smaller studies showed &#8220;negativization&#8221; of the HCV RNA later in infancy after a positive test result in the neonatal period&#44; suggesting that in some infants&#44; postnatal viremia may be transient or that po-lymerase chain reaction assays to detect HCV RNA are not completely reliable&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Therefore&#44; the diagnosis of vertical infection is established by the presence of detectable serum HCV RNA on two occasions&#44; assessed three to four months apart&#44; after the infant is at least two months old and&#47;or by the detection of anti-HCV antibodies at 18 months of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Glutamic piruvic transaminase &#40;GPT&#41; and anti-HCV antibodies should be investigated at 18-24 months of life in children born to anti-HCV-positive&#44; HCV-RNA-negative mothers&#46; Follow-up is not necessary if GPT is normal and anti-HCV antibodies are undetectable&#46; HCV-RNA-negative children with abnormal GPT born to HCV-RNA-positive mothers should be tested again for viremia at 6-12 months of age and for anti-HCV antibodies at 18 months of age&#46; HCV-RNA-negative children with normal GPT should be tested for anti-HCV antibodies and GPT at 18-24 months of age and should be considered as noninfected if GPT is normal and anti-HCV antibodies are undetectable&#46; Anti-HCV seropositivity beyond the 18<span class="elsevierStyleSup">th</span> month in a never-viremic child with normal GPT is likely consistent with past hepatitis virus infection&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="p0105" class="elsevierStylePara elsevierViewall">Limited data indicate that less than 10&#37; of infected children develop chronic hepatitis&#44; of which less than 5&#37; evolve to cirrhosis&#46; Infection acquired vertically seems to be mild over the first five years and the proportion of these children with resolved infections is higher than that of infants infected at older ages&#44; for which long-term follow-up is necessary to determine whether the infection has resolved or pro-gressed&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Yeung found a vertical transmission of 1&#46;7&#37; in mothers who were anti-HCV-positive but HCV-RNA-negative&#44; and that vertical transmission increased to 4&#46;3&#37; if the mother was HCV-RNA-posi-tive&#46; A similar finding was reported by a European multicentric prospective study&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Risk Factors for Mother-To-Child Transmission</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Viral load</span><p id="p0110" class="elsevierStylePara elsevierViewall">Vertical transmission of hepatitis C is directly correlated with viral load&#46; In general&#8217; a higher concentration of serum HCV RNA implies an increased likelihood of vertical transmission&#44; especially if vire-mia is high at the time of delivery&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Transmission is low &#40;~1-3&#37;&#41; in mothers who are anti-HCV-positi-ve but have no detectable HCV RNA&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">HIV coinfection</span><p id="p0115" class="elsevierStylePara elsevierViewall">Several studies showed that HIV coinfection favors mother-to-child HCV transmission&#44; as the im-munosuppression produced by the HIV virus causes a high level of viremia in the mother&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Blac-kard demonstrated that HIV infection facilitates HCV entry and replication in blood cells&#8217; which is a risk factor for perinatal transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Most of the coinfected mothers had used illicit drugs&#46; The risk of vertical transmission is considered as ~19&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> although this number seems to decrease &#40;8&#46;7&#37;&#41; when the patients receive high-activity antiretroviral treatment &#40;HAART&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> These results suggest that coinfected pregnant women should be treated with HAART to reduce the risk of perinatal transmission of HIV and HCV&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Intravenous drug addiction</span><p id="p0120" class="elsevierStylePara elsevierViewall">Several well-performed studies showed that maternal intravenous drug addiction increases the risk of perinatal transmission of HCV&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Infection of peripheral blood mononuclear cells with HCV occurs more frequently in these women compared with women without a history of intravenous drug use&#44; which may favor the infection of the newborn&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Infection of the father</span><p id="p0125" class="elsevierStylePara elsevierViewall">In a recent study&#8217; Indolfi found that HCV infection of the fathers&#44; who were also the sexual partners of the HCV-infected mothers&#8217; was predictive of HCV vertical transmission and correlated with the history of maternal intravenous drug abuse&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Level of tansaminases</span><p id="p0130" class="elsevierStylePara elsevierViewall">Although the relationship between the histolo-gical degree of HCV in the mother and the likelihood of transmission of HCV infection to the infant has not been explored sufficiently&#44; two recent studies showed that abnormal GPT in the year before pregnancy and at delivery is associated significantly with perinatal transmission of HCV&#46; It is probable that mothers with higher GPT have a more severe disease&#44; which may also mean the presence of a higher viral load&#46; In addition&#44; transaminase abnormalities are associated with higher viral heterogeneity&#44; which is a factor that favors perinatal transmission of both HCV and HIV&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Role of peripheral blood mononuclear cell infection</span><p id="p0135" class="elsevierStylePara elsevierViewall">There is evidence that maternal peripheral blood mononuclear cell infection by HCV and viral repli-cative activity in these cells are closely related to perinatal transmission&#44; and that this phenomenon was more significant in mothers with defined risk factors&#46; These cells may act as vectors of HCV in the fetus and interact with immunological cells of the placental barrier&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Obstetrical factors</span><p id="p0140" class="elsevierStylePara elsevierViewall">Premature rupture of the membrane&#44; occurring more than 6 h before delivery&#44; is associated with an increased risk of perinatal transmission of HCV&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Amniocentesis is a potential risk for the spread of HCV infection to the infant&#44; although HCV was found in the amniotic fluid of only 6&#46;3&#37; of viremic mothers who underwent am-niocentesis during the fourth month of pregnan-cy&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Invasive monitoring of the fetus in labor with a scalp electrode or exposure of the infant to maternal blood infected by HCV because of the occurrence of vaginal or perineal laceration during vaginal delivery increase the risk of perineal transmission of HCV&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Gender of the infant</span><p id="p0145" class="elsevierStylePara elsevierViewall">Previous studies do not demonstrate an association between perinatal transmission of HCV and the gender of the infant&#59;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> however&#44; a recent study revealed that females were twice as likely to be infected as males&#46; This may be because of a greater female biological susceptibility to the infection&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Factors not Associated With Perinatal Transmission</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Mode of delivery</span><p id="p0150" class="elsevierStylePara elsevierViewall">Several observational studies did not show evidence that the mode of delivery &#40;caesarean section <span class="elsevierStyleItalic">vs&#46;</span> vaginal&#41; influences the risk of HCV perinatal transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Currently&#44; there are no randomized controlled trials aimed at evaluating whether caesa-rean section&#44; rather than vaginal labor&#44; reduces HCV perinatal transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> In contrast&#44; an initial study conducted by the European Paediatric Hepatitis C network reported that caesarean section in patients coinfected with HIV protected against HCV transmis-sion&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> A later study of this same group did not confirm these findings&#44; probably because the HCV&#47;HIV coinfected patients received HAART&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Breast feeding</span><p id="p0155" class="elsevierStylePara elsevierViewall">HCV can be found in low levels in maternal milk and in colostrums&#59; however&#44; these levels were not sufficient to transmit the infection&#44; as the virus can be inactivated easily by the gastric juices and&#47;or anti-infectious components of the maternal milk&#46; Therefore&#44; breast feeding is not prohibited in the absence of damaged&#44; cracked&#44; or bleeding nipples&#46; In cases of HCV&#47;HIV coinfection&#44; breast feeding is based on current recommendations for HIV virus&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46</span></a><span class="elsevierStyleSup">-</span><a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Viral genotype</span><p id="p0160" class="elsevierStylePara elsevierViewall">Viral transmission takes place with all known HCV genotypes&#46; To date&#44; no correlation was demonstrated between perinatal transmission and genotype&#46; Mast showed that type 1a was the most prevalent&#44; but not the most virulent genotype&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Recommendations to Pregnant Women With Hepatitis C</span><p id="p0165" class="elsevierStylePara elsevierViewall">In addition to general preventive measures to avoid the transmission of this virus&#44; all HCV-infected patients must be advised to stop alcohol inges-tion and to avoid potentially hepatototoxic drugs&#44; including herbal medicines&#46; Moreover&#44; they should be immunized against hepatitis A and B if they have no protection against these viruses&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Treatment</span><p id="p0170" class="elsevierStylePara elsevierViewall">The state-of-the-art treatment for hepatitis C&#44; which is based on pegylated interferon and ribavi-rin&#44; is currently contraindicated during and immediately before pregnancy&#44; because ribavirin poses a high risk of teratogenicity<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> and alpha interferon is considered as contraindicated in pregnancy and in children less than two years of age because of potential neurotoxicity&#46; Antiviral therapy is not recommended for the prevention of perinatal transmission&#46; Currently&#44; no HCV vaccine is available and its development will probably take a long time because of the multiple viral genotypes and the fast rate of virus mutation&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Future Directions</span><p id="p0175" class="elsevierStylePara elsevierViewall">Additional research is needed to establish whether a nondetectable viral load in hepatitis C bears the same significance for the transmission rate of HCV as it does in HIV infection&#46; Furthermore&#44; it is necessary to determine the level of viremia that may result in perinatal transmission&#44; and whether the use of interferon and ribavirin treatment prior to delivery in patients with a high viral load diminishes or eliminates HCV vertical transmission&#44; as Lami-vudine does in pregnant women infected with hepatitis B virus&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="p0180" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="li0010"><li class="elsevierStyleListItem" id="list0065"><span class="elsevierStyleLabel">1&#46;</span><p id="p0185" class="elsevierStylePara elsevierViewall">The prevalence of HCV in pregnant women is similar to that of the general population&#46;</p></li><li class="elsevierStyleListItem" id="list0070"><span class="elsevierStyleLabel">2&#46;</span><p id="p0190" class="elsevierStylePara elsevierViewall">In general&#44; the infection does not impact the clinical course of pregnancy in the absence of cirrhosis&#59; however&#44; there are reports of prematurity&#44; low birth weight&#44; and microcephaly&#46;</p></li><li class="elsevierStyleListItem" id="list0075"><span class="elsevierStyleLabel">3&#46;</span><p id="p0195" class="elsevierStylePara elsevierViewall">The risk of vertical transmission is low &#40;~4&#37;&#41; and correlates with high viral load&#44; the use of illicit drugs&#44; and HIV coinfection&#46;</p></li><li class="elsevierStyleListItem" id="list0080"><span class="elsevierStyleLabel">4&#46;</span><p id="p0200" class="elsevierStylePara elsevierViewall">Mode of delivery&#44; breast feeding&#44; and viral genotype do not correlate with vertical transmission&#46;</p></li><li class="elsevierStyleListItem" id="list0085"><span class="elsevierStyleLabel">5&#46;</span><p id="p0205" class="elsevierStylePara elsevierViewall">At present&#44; there are no recommendations for the treatment of HCV infection during pregnancy&#44; or effective measures to decrease vertical transmission&#46;</p></li></ul></p></span></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos