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Hepatitis C in pregnancy
  1. N Hadžić
  1. Department of Child Health, King's College Hospital, Denmark Hill, London SE5 9RJ, United Kingdom
  1. Dr Hadžićnedim.hadzic{at}

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At the end of the second millennium, chronic hepatitis C virus (HCV) infection is recognised as a major public health problem. The global prevalence of chronic HCV infection is estimated to be approaching 3% (over 170 million HCV infected people) with considerable geographical variation, ranging from 0.01–0.1% in the United Kingdom and Scandinavia to 17–26% in Egypt.1 At present, the infection rate peaks among adults aged 30–49 and declines sharply in those older than 50 years, suggesting acquisition of HCV within the past 10–30 years.1 In the United States, the estimated anti-HCV prevalence in 6–11 year old children is 0.2%, and among adolescents aged 12–19 it is 0.4%.2 ,3 HCV induced end stage chronic liver disease is a leading indication for transplantation in the adult population of the United States.1 ,2 Anti-HCV screening of blood products introduced during the early 1990s has minimised this mode of HCV acquisition, leaving vertical transmission from infected mothers as the predominant mode of infection in children. Theoretically, vertical transmission of HCV may occur at conception, in utero, perinatally, or during lactation. However, its mechanisms, including timing, remain largely unknown.

HCV and conception

Any significant chronic liver disease may render both women and men subfertile through a combination of pathogenic mechanisms. Most female patients with chronic HCV, however, will not develop end stage chronic liver disease during their fertile period. A recent study from Ireland followed up a group of 36 rhesus negative women infected with HCV type 1b following postnatal exposure to contaminated anti-D immunoglobulin.4 Over 20 years, despite the presence of biochemical abnormalities in 55% and liver fibrosis in 42%, there were a total of 100 pregnancies, with no difference in the incidence of spontaneous miscarriages, premature deliveries, and obstetric interventions compared with controls. None of the 53 HCV …

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