Erika Barth Cottrell, PhD, MPP; Roger Chou, MD; Ngoc Wasson, MPH; Basmah Rahman, MPH; Jeanne-Marie Guise, MD, MPH
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Robin Paynter, MLIS; Rose Campbell, MLIS; Christina Bougatsos, MPH; Ian Blazina, MPH; Tracy Dana, MLS; Jessica Griffin, MS; AHRQ Task Order Officer Christine Chang, MD, MPH; and USPSTF Medical Officer Iris Mabry-Hernandez, MD, MPH.
Grant Support: By AHRQ (contract 290-2007-10057-I, task order 8), Rockville, Maryland.
Potential Conflicts of Interest: Disclosures can be found at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1651.
Requests for Single Reprints: Roger Chou, MD, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Cottrell, Chou, Wasson, Rahman, and Guise: 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239.
Author Contributions: Conception and design: R. Chou, J.M. Guise.
Analysis and interpretation of the data: E.B. Cottrell, R. Chou, N. Wasson, J.M. Guise.
Drafting of the article: E.B. Cottrell, R. Chou, B. Rahman, J.M. Guise.
Critical revision of the article for important intellectual content: E.B. Cottrell, R. Chou, N. Wasson, J.M. Guise.
Final approval of the article: E.B. Cottrell, R. Chou, N. Wasson, J.M. Guise.
Statistical expertise: R. Chou.
Obtaining of funding: R. Chou, J.M. Guise.
Administrative, technical, or logistic support: R. Chou, N. Wasson, B. Rahman, J.M. Guise.
Collection and assembly of data: R. Chou, N. Wasson, B. Rahman, J.M. Guise.
Mother-to-infant transmission is the leading cause of childhood hepatitis C virus (HCV) infection, with up to 4000 new cases each year in the United States.
To evaluate effects of mode of delivery, labor management strategies, and breastfeeding practices on risk for mother-to-infant transmission of HCV.
MEDLINE (1947 to May 2012), the Cochrane Library Database, clinical trial registries, and reference lists.
Randomized trials and observational studies on mode of delivery, labor management strategies, and breastfeeding practices and risk for mother-to-infant transmission of HCV.
Investigators abstracted and reviewed study details and quality using predefined criteria.
Eighteen observational studies evaluated the association between mode of delivery, labor management strategies, or breastfeeding practices and risk for mother-to-infant HCV transmission. Fourteen studies (2 good-quality, 4 fair-quality, and 8 poor-quality studies) found no clear association between mode of delivery (vaginal versus cesarean delivery) and risk for transmission. Two studies (1 good-quality and 1 poor-quality study) reported an association between prolonged duration of ruptured membranes and increased risk for transmission. Fourteen studies (2 good-quality, 2 fair-quality, and 10 poor-quality studies) found no association between breastfeeding and risk for transmission.
Only English-language articles were included. Studies were observational, and most had important methodological shortcomings, including failure to adjust for potential confounders and small sample sizes.
No intervention has been clearly demonstrated to reduce the risk for mother-to-infant HCV transmission. Avoidance of breastfeeding does not seem to be indicated for reducing transmission risk.
Agency for Healthcare Research and Quality.
Summary of evidence search and selection.
The flow diagram summarizes the search and selection of articles addressing the effect of mode of delivery, labor management strategies, or breastfeeding practices on risk for mother-to-infant transmission of hepatitis C virus. Reproduced from reference 9.
* Includes hand searches and gray literature searches.
† One study resulted in 2 publications.
Studies on Mode of Delivery, Labor Management Strategies, and Breastfeeding Practices and Mother-to-Infant Transmission of HCV
Summary of Evidence: Effect of Mode of Delivery, Labor Management Strategies, or Breastfeeding Practices on Risk for Mother-to-Child Transmission of HCV
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Cottrell EB, Chou R, Wasson N, Rahman B, Guise J. Reducing Risk for Mother-to-Infant Transmission of Hepatitis C Virus: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. ;158:109–113. doi: 10.7326/0003-4819-158-2-201301150-00575
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Published: Ann Intern Med. 2013;158(2):109-113.
Gastroenterology/Hepatology, Infectious Disease, Prevention/Screening, Viral Hepatitis.
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