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Delivery method, breastfeeding did not impact mother-to-infant HCV transmission risk

Results from a recent systematic review indicate no clear associations between the risk for mother-to-infant HCV transmission and breastfeeding practices, labor management or method of delivery.

Researchers evaluated 18 observational studies on variables that affected mother-to-infant transmission of HCV. Each study’s quality was rated good, fair or poor, and the strength of the evidence was classified high, moderate, low or insufficient.

The effect of delivery mode on HCV transmission was assessed in 14 studies, with sample sizes ranging from 56 to 1,034 mother/infant pairs. Two studies were considered good quality, four fair and the remainder poor. The good- and fair-quality studies (n=2,080 pairs) each compared HCV transmission risk for elective cesarean delivery to that of vaginal or emergency cesarean delivery. Three studies found the risk greater with vaginal or emergency cesarean delivery, but the difference was significant only in one fair-quality study. The other study found a greater HCV transmission risk associated with elective cesarean delivery.

Vaginal delivery was compared with all cesarean delivery methods in 11 studies (n=2,308 pairs). In 10 studies, there was no link between HCV transmission risk and delivery; the remaining (poor-quality) study indicated a significant risk increase associated with vaginal delivery for women with high HCV RNA levels. Evidence comparing any cesarean procedure to vaginal delivery was considered of moderate quality; evidence comparing elective cesarean to vaginal delivery was rated low quality.

Three studies — including two of good quality and one fair quality — evaluated a potential association between internal fetal monitoring and HCV vertical transmission. One good-quality study revealed an increased risk with monitoring and a larger study indicated no association. Evidence for these studies was considered insufficient. Two studies, including one of good quality and one of poor quality (n=245 pairs), indicated an association between increased HCV transmission risk and a longer duration of membrane rupture. Evidence was rated low quality.

No association between transmission risk and breastfeeding was observed within 14 cohort studies (n=2,971 pairs), including two of good quality, two fair and 10 of poor quality. Evidence among these studies was rated moderate quality.

“Vertical transmission is the leading cause of childhood HCV infection, and identification of effective management strategies to reduce risk for transmission is an important clinical and public health concern,” the researchers wrote. “However, the primary finding of this review … is that no perinatal management strategy has clearly been shown to reduce risk for HCV transmission.”

Disclosure: See the study for a full list of relevant disclosures.