Hepatitis C in pregnancy

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Slide 1 :

HEPATITIS-C AND PREGNANCY Ashok Kumar, K Aparna sharma, R.K Gupta, Anita Chakravarti, P Kar DEPARTMENT OF OBSTETRICS & GYNAECOLOGY, MAULANA AZAD MEDICAL COLLEGE & LOK NAYAK HOSPITAL NEW DELHI-110002

Slide 2 :

Long term morbidity & mortality Chronic active hepatitis (70%), Cirrhosis (20-30%), Liver failure. Vertical transmission 7% 1-6 % of cirrhotics will develop hepatocellular carcinoma every year. 25% of HIV infected patients have HCV co-infection

Slide 3 :

Prevalence of antiHCV in antenatal clinic National Surveys Greater London area 0.43% ( of 25938 women) Northern & Yorkshire region 0.21% ( of 16675 women) Inner districts of London 0.38% Outer districts of London 0.20% West Midlands 0.14%. Scotland 0.29-0.40% (of 30,259 women) New Delhi : 1.5% ( 65 pregnant women), 1995 Shimla : 0 ( 250 pregnant women), 2001 Geographical variation : 0.6% (Japan) - 4.5% (United States )

Slide 4 :

Aims and Objectives To study the prevalence of Hepatitis C virus infection among the pregnant women attending the antenatal clinic. To determine whether various risk factors for HCV infection could be identified. To study the effect of Hepatitis C infection on the course and outcome of the pregnancy.

Slide 5 :

Materials and Methods Institute ethic committee approval Supported & Funded by ICMR Study period : Aug.2003-July.2006. Place : Antenatal Clinic Subjects : 8130 healthy pregnant women Interview : Demography & Risk factors Exclusion criteria :women’s with previous liver disease

Slide 6 :

Anti HCV : Third generation HCV Elisa kit retested in duplicate considered ELISA positive, - if at least two of three results were reactive. Anti-HCV positive subjects tested for : HCV-RNA by RT-PCR. HBsAg, HBcIgG, HBeAg Human Immunodeficiency Virus (Microlisa-HIV Elisa ) LFT were performed in all cases at registration & delivery. Materials and Methods

Slide 7 :

HCV positive patients : 84 (1.03%) of 8130 pregnant women 46 (54.8%) HCV-RNA positive 4 (4.8%) HBsAg positive, none HIV positive. counseled at a subsequent antenatal visit followed for their pregnancy outcomes Data Analysis : SPSS for Windows version 9.0. Univariate analysis for categorical variables by using X2 and Fisher’s exact test

Slide 8 :

Age Distribution p. > 0.05

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Parity & Literacy status P > 0.05 Seropositive N=84 Seronegative N=8046

Slide 10 :

Risk factors 8130 pregnant women Blood transfusion - 257 (3.2%) D&C - 1114 (13.7%) Abortion - 1270 (15.7%) Tattoo application / acupuncture - 839 (10.3%) Surgery - 1017 (12.5%) Multiple sexual partners / injected drugs 0

Slide 11 :

Risk Factors analysis in pregnant population

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Of the 84 anti-HCV positive women , 52 (61.9 %) did not have any identifiable risk factors . 40% to 73% of the women had no obvious risk factors 25% to 30% of women are aware of their diagnosis Options: *selective antenatal screening based on risk factors * universal screening in pregnancy is not cost-effective Routine screening is not recommended

Slide 13 :

Resource poor countries : Recommendations ??? . ____________________. Screening for HCV infection 1

Slide 14 :

Anti HCV positive n=78 AST ALT Mean 36.8 + 18 IU/L 33.1 + 18.8 IU/L Range 18-135 15-153 63 (80.8%) had normal liver function tests. 15 (19.2%) had elevated ALT (>40 IU/L) 13 (16.7%) had elevated AST (>40 IU/L) HCV RNA positive n=46 AST ALT Mean 36.1 + 14.6 IU/L 33.3 + 15.2 IU/L Range 21-84 18-96 10 (21.7%) of 46 HCV-RNA positive : abnormal ALT 6 (18.7%) of HCV-RNA negative : abnormal ALT (p value > 0.05).

Slide 15 :

AST and ALT levels did not deteriorate from the time of first visit to the time of delivery. 2

Slide 16 :

Pregnancy out come in Anti-HCV seropositive and seronegative groups.

Slide 17 :

Pregnancy outcome: Anti-HCV seropositive & seronegative groups

Slide 18 :

anti HCV positive anti HCV negative Mean 2819.42 + 389.4 gms 2721.64 + 425.7 gms birth wt (range 1700-3820) ( range 900-4000) (p value > 0.05).

Slide 19 :

Outcome of pregnancy not adversely affected by HCV infection. Overall, women with chronic hepatitis C usually have uneventful pregnancies. HCV infection did not : increase the risk of obstetric complications influence the fetal-neonatal status at delivery. 3

Slide 20 :

Thank You

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