Perinatal Hepatitis C Exposure

1. Indications: Screening in pregnant women
   1. See Hepatitis C for risk factors
2. Pathophysiology
   1. Vertical transmission Risk
      1. Mother HCV Ab positive and HCV RNA negative: 1.7% vertical transmission rate of HCV
      2. Mother HCV Ab Positive and HCV RNA positive: 4.3% vertical transmission rate of HCV
      3. Mother HCV Ab Positive and Comorbid HIV positive: 19.4% vertical transmission rate of HCV
3. Labs: Diagnosis of Hepatitis C in infant
   1. Initial false positive testing due to persists maternal HCV antibodies in infant for upwards of one year
   2. Diagnostic criteria
      1. HCV RNA positive on each of 2 samples from infant between age 2 and 6 months
      2. Absent HCV Antibody after 15 months suggests infant is HCV negative
4. Management: HCV positive mother
   1. Gastroenterology referral for Hepatitis C infected mother
   2. Interferon and Ribavirin protocol contraindicated in pregnancy (Ribavirin is Teratogenic)
5. Management: Infant
   1. Factors that do not impact transmission
      1. Ceserean section does not reduce transmission
      2. Breast Feeding does not increase transmission rate
6. References
   1. Airoldi (2006) Obstet Gynecol Surv 61(10): 666-72