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Vertical HCV transmission continues due to ineffective intervention
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No intervention has been clearly demonstrated to reduce the risk for mother-to-infant hepatitis C virus transmission, including avoidance of breast-feeding, according to a recent review of the literature.
Erika Barth Cottrell, PhD, MPP, and colleagues from Oregon Health & Science University, Portland, Ore., conducted a systematic review to evaluate effects of mode of delivery, labor management strategies, and breast-feeding practices on risk for mother-to-infant transmission of HCV.
They analyzed 18 observational studies that evaluated the association between mode of delivery, labor management strategies or breast-feeding practices, and risk for vertical HCV transmission. For prenatal screening to be effective, according to the study findings, there must be an effective intervention.
“Our findings indicate that avoidance of breast-feeding is not warranted to reduce risk for vertical transmission. Given limited evidence of an association between prolonged rupture of membranes and increased transmission risk, clinicians may consider avoiding prolonged rupture of membranes in HCV-infected women until more definitive data are available,” the study researchers wrote.
Vertical transmission is the main route of childhood HCV infection. Approximately 40,000 children worldwide are born annually to mothers who are HCV positive; 4,000 of those are US cases. Previous studies have estimated the rate of vertical transmission range from 3% to 10%. Risk for transmission is highest among women with a high viral load at delivery and those coinfected with HIV, according to background information provided in the study.
Cottrell and colleagues said the conclusion could have some limitations, including that the evidence regarding the effects of interventions to prevent vertical transmission was restricted to observational studies and small sample sizes. In addition, they included only English-language articles in their analysis.
Disclosure: This study was funded by the Agency for Healthcare Research and Quality.
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