John F. Reinus, MD; Enid L. Leikin, MD; Harvey J. Alter, MD; Ling Cheung, MD; Michiko Shindo, MD, PhD; Betsy Jett, BS; Steve Piazza, MD; J. Wai-Kuo Shih, PhD
▪ Objective: To search for transmission of hepatitis C virus (HCV) from infected mothers to their infants.
▪ Design: Prospective clinical, serologic, and molecular biologic follow-up (at least 3 months) of the infants of mothers with anti-HCV antibody.
▪ Setting: A county hospital providing primary and referral care in high-risk obstetrics (perinatology).
▪ Patients: Twenty-three mothers with anti-HCV antibody and their 24 infants.
▪ Methods: An enzyme-linked immunosorbent assay (EIA) and a four-antigen recombinant immunoblot assay (RIBA) were used to test for anti-HCV antibody; serum HCV RNA was measured in two independent laboratories by reverse transcription and polymerase chain reaction (PCR) using nested primers in the 5′-noncoding region. Infant samples were tested for HCV RNA by PCR at delivery and after 3 to 6 months of follow-up. Each sample was tested at least four times in two independent laboratories.
▪ Results: Twenty-nine of 648 mothers (4.5%; 95% Cl, 3.0% to 6.4%) had anti-HCV antibody; these women had 30 babies. Twenty-three mothers and their 24 babies were followed at least 3 months (mean follow-up, 52 weeks). Of the 23 mothers, 21 (91%; Cl, 72% to 99%) had a reactive RIBA; one woman had an indeterminate RIBA and was positive for HCV RNA by PCR. In 16 of 23 mothers (70%; Cl, 47% to 87%), PCR yielded a positive result in both laboratories. The mean maternal alanine aminotransferase (ALT) level was 1.6 times the normal value. All the babies had anti-HCV antibody in cord-blood samples, but antibody disappeared or diminished in strength in interval samples, and no infant had evidence of active production of anti-HCV antibody. Only 1 of 24 (4%; Cl, 0.1% to 21%) cord-blood samples was HCV RNA positive, and none of 24 (0%; Cl, 0% to 14%) follow-up samples was positive for HCV RNA by PCR in either laboratory. Four mothers and one baby had antibody to HIV.
▪ Conclusions: Infant anti-HCV antibody is most likely acquired passively in utero, and vertical transmission of HCV is uncommon.
Reinus JF, Leikin EL, Alter HJ, Cheung L, Shindo M, Jett B, et al. Failure To Detect Vertical Transmission of Hepatitis C Virus. Ann Intern Med. ;117:881–886. doi: 10.7326/0003-4819-117-11-881
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Published: Ann Intern Med. 1992;117(11):881-886.
Gastroenterology/Hepatology, Infectious Disease, Viral Hepatitis.
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