ALT
Levels Prior to Pregnancy Predict Risk of HCV Vertical Transmission By
Liz Highleyman  Mother-to-child
transmission of the hepatitis C virus (HCV) may occur during pregnancy or
delivery. Most studies indicate that the overall rate of perinatal transmission
is low -- less than 5% -- but various factors can increase the risk, including
high maternal HCV viral load and coinfection with HIV.
According
to a study reported in the July 2006 Journal of Medical Virology, the mother's
alanine transaminase (ALT) level during
the year before pregnancy may also predict the risk of vertical HCV
transmission. The
analysis included 74 mothers who transmitted HCV to their infants and 403 HCV
positive mothers who did not. All enrolled women received two ALT measurements,
at least six months apart, in the year before they became pregnant. The
researchers categorized the women into one of two groups: 
Normal: those with persistently normal serum ALT levels;
Abnormal: those with either consistently elevated ALT (more than twice the upper
limit of normal) or fluctuating ALT levels (one normal and one elevated measurement).
Results
52.7% of mothers (39 out of 74) who transmitted HCV had abnormal ALT levels, compared
with 32.6% mothers (146 out of 403) who did not transmit the virus (P = 0.008;
relative risk 1.96; 95% CI 1.19-3.23).
Mothers with consistently elevated ALT were more likely to transmit HCV than those
with fluctuating ALT levels.
Conclusion The
authors concluded that increased ALT levels may reflect more severe liver disease
and a higher viral load, which is known to be associated with an increased risk
of vertical transmission. They suggested that the inexpensive and widely available
ALT test may help identify mothers with an increased risk of HCV vertical transmission,
which could be particularly beneficial in settings where more expensive laboratory
tests (such as HCV RNA) are unavailable or unaffordable. 7/21/06 Reference
G
Indolfi, C Azzari, M Moriondo, and others. Alanine transaminase levels in the
year before pregnancy predict the risk of hepatitis C virus vertical transmission.
Journal of Medical Virology 78(7): 911-914. July 2006. | 
