Article

Reducing Risk for Mother-to-Infant Transmission of Hepatitis C Virus: A Systematic Review for the US Preventive Services Task Force

Oregon Health & Science University, Portland, USA.
Annals of internal medicine (Impact Factor: 17.81). 01/2013; 158(2):109-13. DOI: 10.7326/0003-4819-158-2-201301150-00575
Source: PubMed

ABSTRACT

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.

Download full-text

Full-text

Available from: Jeanne-Marie Guise, Jul 15, 2014
  • Source
    • "Certain factors are thought to intensify the probability of HCV vertical transmission. In most vertically transmitted HCV cases, it has been observed that the infected mother used to be coinfected with HCV/HIV[13,14]compared to those infected with HCV alone[9]. According to metaanalysis of multiple studies, it is clear that HCV/HIV coinfection during pregnancy period enhances the chance of vertical transmission by 90%[13]. "

    Full-text · Article · Jan 2016 · Archives of Clinical Microbiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Identification of hepatitis C virus (HCV)-infected persons through screening could lead to interventions that improve clinical outcomes. PURPOSE: To review evidence about potential benefits and harms of HCV screening in asymptomatic adults without known liver enzyme abnormalities. DATA SOURCES: English-language publications identified from MEDLINE (1947 to May 2012), the Cochrane Library Database, clinical trial registries, and reference lists. STUDY SELECTION: Randomized trials and cohort, case-control, and cross-sectional studies that assessed yield or clinical outcomes of screening; studies reporting harms from HCV screening; and large series reporting harms of diagnostic liver biopsies. DATA EXTRACTION: Multiple investigators abstracted and checked study details and quality by using predefined criteria. DATA SYNTHESIS: No study evaluated clinical outcomes associated with screening compared with no screening or of different risk- or prevalence-based strategies. Three cross-sectional studies in higher prevalence populations found screening strategies that targeted multiple risk factors were associated with sensitivities greater than 90% and numbers needed to screen to identify 1 case of HCV infection of less than 20. Data on direct harms of screening were sparse. A large study of percutaneous liver biopsies (n = 2740) in HCV-infected patients with compensated cirrhosis reported no deaths and a 1.1% rate of serious adverse events (primarily bleeding and severe pain). LIMITATIONS: Modeling studies were not examined. High or unreported proportions of potentially eligible patients in the observational studies were not included in calculations of screening yield because of unknown HCV status. CONCLUSIONS: Although screening tests can accurately identify adults with chronic HCV infection, targeted screening strategies based on the presence of risk factors misses some patients with HCV infection. Well-designed prospective studies are needed to better understand the effects of different HCV screening strategies on diagnostic yield and clinical outcomes. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
    Full-text · Article · Nov 2012 · Annals of internal medicine
  • Source

    Preview · Article · Dec 2012 · Revista Colombiana de Gastroenterologia
Show more