Elsevier

Journal of Hepatology

Volume 32, Issue 2, February 2000, Pages 293-299
Journal of Hepatology

Decrease in serum ALT and increase in serum HCV RNA during pregnancy in women with chronic hepatitis C

https://doi.org/10.1016/S0168-8278(00)80075-6Get rights and content

Abstract

Background/Aims: The natural history of chronic hepatitis C infection during pregnancy has not been clearly established, and thus our aim was to assess serum alanine aminotransferase levels and serum HCV RNA levels during pregnancy.

Methods: Twenty-six pregnant women with chronic hepatitis C were studied. Serum alanine aminotransferase was assessed within the 3 months before, monthly during and within the 3 months after pregnancy. In 12 women, serum HCV RNA levels were quantified by the branched DNA assay. Twenty-six age-matched non-pregnant women with chronic hepatitis C were followed up for 1 year, and used as a comparison group.

Results: During pregnancy, serum alanine aminotransferase levels decreased in the second and third trimesters. The third trimester levels were significantly lower than serum alanine aminotransferase levels before pregnancy (p=0.0001). Seventy-seven percent of the pregnant women with increased pre-pregnancy levels had normalization of serum alanine aminotransferase levels. In the second or third trimesters, serum HCV RNA levels increased. The third trimester serum HCV RNA levels were significantly higher than levels before pregnancy (p=0.01). No significant change in serum alanine aminotransferase or HCV RNA levels was observed in the control group.

Conclusion: In pregnant women with chronic hepatitis C, serum alanine aminotransferase levels decrease, and serum HCV RNA levels increase during the second and third trimesters.

Section snippets

Patients and Methods

Between 1992 and 1997, 26 women with a monofetal pregnancy and chronic hepatitis C were followed in two liver units (21 in Hôpital Beaujon, Clichy, and 5 in Hôpital Trousseau, Tours). All patients were anti-HCV positive (ELISA and RIBA, Ortho Diagnostic Systems, Roissy, France) and were serum HCV RNA positive (Amplicor, Roche, Neuilly sur Seine, France). Thirteen of the 26 women had histologically proven hepatitis on liver biopsy performed within 2 months to 2 years before the onset of

Results

The clinical characteristics of the pregnant and the non-pregnant women were similar: median age 33 years (range: 24 to 44 years) in pregnant women versus 34 years (range: 24 to 42 years) in non-pregnant women; duration of infection was 10 years in both groups (Table 1). Pregnancies reached a mean term of 39 weeks (33 to 42 weeks). Serum HCV RNA was not detectable by PCR in any children 1 year after birth.

Discussion

This study evaluated the changes in serum ALT and serum HCV RNA levels during pregnancy in women with chronic hepatitis C. There was a frequent decrease, and even normalization, of serum ALT levels during the second and the third trimesters of pregnancy (77% of the pregnancies studied). As serum ALT decreased, the viral load increased during pregnancy, and this phenomenon reached a peak in the third trimester of pregnancy. Within the 3 months after delivery, serum ALT levels increased again and

Acknowledgements

We thank Dr Marie-Claude Bréchot (Laboratoire de Biochimie, Hôpital Trousseau, Tours, France) and Véronique Lebreton (INSERM U481, Hôpital Beaujon Clichy, France) for their technical assistance.

Grant support: this study was supported by a grant from the Association Recherche et Partage.

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