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Prospective cohort study of children exposed to hepatitis C virus through a pregnancy screening program
Raquel Borges Pinto1, Ana Regina L Ramos1, Leidy Tovar Padua2
1Hospital da Criança Conceição, Porto Alegre, RS, Brazil.
Insights
Hepatitis C virus (HCV) infection is underdiagnosed in pregnant women in Brazil, leading to high vertical transmission rates. Early screening and public health interventions are crucial for prevention and treatment in this population.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Porto Alegre, Brazil, exhibits high Hepatitis C Virus (HCV) infection rates.
- Routine prenatal screening for HCV has been lacking.
- HCV poses a significant public health challenge, particularly in vulnerable populations.
Purpose of the Study:
- To assess HCV seroprevalence and vertical transmission rates among pregnant women and their infants in Porto Alegre.
- To identify risk factors associated with HCV viremia in pregnant women.
- To evaluate the outcomes of HCV infection in infants born to infected mothers.
Main Methods:
- A longitudinal study involving pregnant women and their infants from January 2014 to December 2018.
- HCV antibody screening offered to all delivering women; seropositive cases confirmed with HCV RT-PCR.
- Prospective follow-up of infants born to HCV-positive mothers.
Main Results:
- HCV seroprevalence was 0.7% (130/17,810) among screened pregnant women.
- HCV RNA was detected in 48.7% of seropositive women; viremia linked to drug use and sexual history.
- The vertical transmission rate was 13.9% (6/43 infants), with genotype 3 prevalent in infected infants.
Conclusions:
- HCV vertical transmission is notably high in this Brazilian population.
- HCV infection during pregnancy is significantly underdiagnosed.
- Targeted public health strategies are essential for disease prevention and early treatment in pregnant women and newborns.
Objectives:
Porto Alegre, in south Brazil, has one of the highest hepatitis C virus (HCV) infection rates in the country (84.4 cases/100 000 in 2018). Prenatal screening of HCV, however, has not been routinely offered.
Methods:
A longitudinal study of pregnant women with HCV and their infants was conducted between January 2014 and December 2018. Screening for HCV antibodies was offered to all women delivering at the study tertiary institution. HCV RT-PCR was performed if the woman was seropositive. Infants were followed prospectively.
Results:
Among 18 953 pregnant women delivering infants during the study period, 17 810 were screened for HCV antibodies (93.9%) with 130 positive results (HCV seroprevalence 0.7%). HCV-RNA was detectable in 57/117 cases (48.7%). HCV viremia was associated with the use of injectable drugs (P = 0.03), inhaled/crack drug use (P = 0.02), having an HCV-seropositive partner, and ≥3 lifetime sexual partners (P < 0.01). Genotype 1 was most prevalent (68%) during pregnancy. Among 43 children with follow-up, six (13%) were HCV-infected (transmission rate 13.9%); 50% were infected with genotype 3. Two infants (33%) cleared their infection; the mothers had genetic polymorphisms associated with clearance.
Conclusion:
HCV vertical transmission was high in the study population, with HCV infection during pregnancy being vastly underdiagnosed. Public health efforts must focus on this vulnerable population for disease prevention and early treatment.
