Hepatitis C
virus (HCV) may be transmitted perinatally from mother
to child during pregnancy or delivery. This may occur if the mother has significant
HCV viremia, and is more likely if she is coinfected
with HIV. As yet, there are no appropriate interventions to prevent perinatal
HCV transmission.
In
the February 2007 Journal of Clinical Virology, British researchers reported
on 4 cases in which only 1 member of a pair of twins was perinatally infected
with HCV.
The
investigators searched a laboratory database for all twins referred for HCV testing
at the Children's Hospital Liver Unit in Birmingham, England. The mothers and
their healthcare providers were contacted to obtain further information about
the pregnancies and deliveries of all the twins.
Results
•
4 sets of twins were
investigated for HCV.
•
In all cases, only
1 twin had been infected with HCV.
•
In 3 out of 4 cases,
the second twin became infected.
•
All of the infected
twins were girls.
•
The larger twin in
each pair became infected.
•
HCV transmission was
associated with premature rupture of membranes in the only case in which the first-born
twin was infected.
•
There was no invasive
fetal monitoring or episiotomy in any of the deliveries
Conclusion
"Transmission
of HCV is more likely to affect the second twin, perhaps because placental separation
during the delivery of the second twin exposes the infant to infection,"
the researchers concluded.
They
added that, "Until effective interventions such as vaccination of newborns
or antiviral treatment of mothers are evaluated, elective caesarean section could
be recommended for HCV twin pregnancies in order to avoid premature membrane rupture
and infection of the second twin."
Liver
Unit, Birmingham Children's Hospital NHS Trust, Birmingham, UK; Health Protection
Agency, Public Health Laboratory, Heart of England NHS Trust, Birmingham, UK.
02/16/07
Reference E
Boxall, K Baumann, N Price, and others. Discordant outcome of perinatal transmission
of hepatitis C in twin pregnancies. Journal of Clinical Virology 38(2):
91-95. February 2007.
