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HEPATITIS \'C\' IN PREGNANCY

HEPATITIS CIN PREGNANCY
In India alone, the death rates from Hepatitis C exceed over 100, 000 per year. 1 in 5 patients with chronic HCV develops irreversible liver damage (cirrhosis) and about 1 in 4 patients with cirrhosis progress to liver failure and die. In India, approximately 18 million people are estimated to be infected. Punjab alone shares five to seven percent of this sick Indian population. The world wide ratio of occurrence of the disease is one out of 12 individuals. Shockingly, the ratio for Punjab is one out of 16 individuals.
However, this condition has not received as much attention as other infections conditions, notably AIDS, because of ignorance about the disease and the absence of effective treatment options.
The infection is caused by the Hepatitis C Virus (HCV) that enters the body through two main routes parenteral (through blood) and non-prenateral (sexual or vectors). The incubation period of the infection is 2-26 weeks i.e., the symptoms may take this much time to appear after a person has been infected. It may take as long as 5-10 years for an infected person to develop chronic liver disease after exposure to the virus.
The transmission of the virus by the parenteral route can occur through a variety of ways, the most common being through blood is infected. Other ways through which the virus may be transmitted are:
►► Intra-venous drug use – through infected syringes used during drug usage
►► Body fluids like saliva/vaginal secretions etc. However, this form of transmission is very rare and occurs only in rare cases.
►► Siblings and children of infected persons may contract the disease through sharing contaminated instruments like razors, tooth brushes, etc.
►► Piercing of the skin as in the case of ear piercing, tattooing etc., with non-sterilized instruments increases the risk of exposure to the virus.
►► Though breast-feeding does not cause transmission of the infection, mothers who show symptoms of Hepatitis C infection should refrain from breast-feeding their children. The transmission of the infection is not dependant upon the type of delivery.
Pregnancy is an important event in life of any woman. To ensure that pregnancy result in a healthy mother and baby, much care of expectant mother is necessary. Any impairment in the health of pregnant woman can lead to disastrous consequences for both, mother and child. In pregnancy, infections pose one of greatest danger. Be it is a bacteria, virus or any other microorganism, infection can influence well-being of mother as well as child. One such infection is hepatitis C virus or HCV.
Generally, pregnancy does not affect the course of the hepatitis, unless a woman has hepatitis E, which can cause severe disease in some patients. Pregnancy itself will not accelerate the disease process, but if the liver is already burdened and scarred with cirrhosis, the additional stress of pregnancy may predispose the expectant mother to a condition called acute fatty liver of pregnancy.
Most women become pregnant during the years between 20 and 40, which is also the age group in which the incidence of hepatitis C infection rises most quickly. Any woman with risk factors for hepatitis C should be screened for hepatitis C before and during pregnancy.
The risk of pregnant woman passing the hepatitis C virus to her unborn child has been related to the levels of quantitative RNA levels in her blood, and also whether she is also HIV positive. The risk of transmission to the infant is less (0 to 18%) if the mother is HIV negative and if she has no history of i.v. drug use or of blood transfusions. Transmission of the virus to the fetus is highest in women with hepatitis C RNA titer greater than 1 million copies/mL. Mothers without hepatitis C RNA levels detected did not transmit hepatitis C infection tot heir infants.
There is no preventive treatment at this time that can influence the rare of transmission of the virus from mother to infant.
A pregnant woman with hepatitis will need to have her liver function tests checked on a regular basis.
In a normal pregnancy, alkaline phosphatase levels can increase three to four times because the placenta creates alkaline phosphate. ALT levels can go up if viral hepatitis or damage to the liver occurs (from drugs, gall stones, severe vomiting, or acute fatty liver of pregnancy).
Transmission does seem to occur in utero, and the rate of transmission is higher in women who have had blood transfusions or used intravenous drugs that in women with no known risk factor for infection.
RISK OF TRANSMISSION OF HCV FROM MOTHER TO FETUS:
Transmission is relatively rare, (less than50%). Transmission of HCV to fetus can occur in pregnancy of during delivery. The risk of a pregnant woman passing the hepatitis C virus to her unborn child is high when the mother is HIV-positive and there are high levels in her blood (greater than 1 million (> 106) copies/ml). The risk is still higher in mothers who are infected with both HBV and HCV. The route of delivery (vaginal vs. caesarean) or amniocentesis in women infected with hepatitis C does not affect the risk of transmission significantly.
reff. health screen

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