Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2022; 28(34): 5023-5035
Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.5023
Pregnancy and fetal outcomes of chronic hepatitis C mothers with viremia in China
Calvin Q Pan, Bao-Shen Zhu, Jian-Ping Xu, Jian-Xia Li, Li-Juan Sun, Hong-Xia Tian, Xi-Hong Zhang, Su-Wen Li, Er-Hei Dai
Calvin Q Pan, Center for Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Calvin Q Pan, Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, NYU School of Medicine, Flushing, NY 11355, United States
Bao-Shen Zhu, Jian-Ping Xu, Jian-Xia Li, Li-Juan Sun, Hong-Xia Tian, Su-Wen Li, Department of Obstetrics and Gynecology, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
Xi-Hong Zhang, School of Public Health, North China University of Science and Technology, Tangshan 063210, Hebei Province, China
Xi-Hong Zhang, Er-Hei Dai, Division of Liver Disease, Department of Medicine, The Fifth Hospital of Shijiazhuang, Hebei Medical University, Shijiazhuang 050021, Hebei Province, China
Author contributions: Pan CQ provided the concept and designed the study, wrote the manuscript, communicated with the journal, and addressed comments from reviewers; Dai EH and Zhu BS obtained the funding and supervised the study; Pan CQ, Zhang XH, and Dai EH performed data analyses; All other authors contributed to the data collection.
Supported by The Ministry of Science and Technology of China for the National Five-Year Key Projects in Infectious Diseases, No. 2015ZX10004801.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Fifth Hospital of Shijiazhuang in China.
Informed consent statement: The informed consent was waived.
Conflict-of-interest statement: Dr. Pan received grants from Gilead. He also serves as a speaker for Gilead and Abbvie. Other authors have nothing to be disclosed.
Data sharing statement: The authors agree to share anonymized Individual Patient Data (IPD) upon request or as required by law and/or regulation with qualified external researchers. Approval of such requests is at the authors’ discretion and is dependent on the nature of the request, the merit of the research proposed, the availability of the data, and the intended use of the data. Data requests should be sent to Erhei Dai MD at email: daieh2008@126.com
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Er-Hei Dai, MD, Professor, Division of Liver Disease, Department of Medicine, The Fifth Hospital of Shijiazhuang, Hebei Medical University, No. 42 Ta’nan Road, Yuhua Distinct, Shijiazhuang 050021, Hebei Province, China. daieh2008@126.com
Received: May 24, 2022
Peer-review started: May 24, 2022
First decision: June 27, 2022
Revised: July 9, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: September 14, 2022
Abstract
BACKGROUND

Data that assess maternal and infant outcomes in hepatitis C virus (HCV)-infected mothers are limited.

AIM

To investigate the frequency of complications and the associated risk factors.

METHODS

We performed a cohort study to compare pregnancy and fetal outcomes of HCV-viremic mothers with those of healthy mothers. Risk factors were analyzed with logistic regression.

RESULTS

Among 112 consecutive HCV antibody-positive mothers screened, we enrolled 79 viremic mothers. We randomly selected 115 healthy mothers from the birth registry as the control. Compared to healthy mothers, HCV mothers had a significantly higher frequency of anemia [2.6% (3/115) vs 19.0% (15/79), P < 0.001] during pregnancy, medical conditions that required caesarian section [27.8% (32/115) vs 48.1% (38/79), P = 0.004], and nuchal cords [9.6% (11/115) vs 34.2% (27/79), P < 0.001]. In addition, the mean neonatal weight in the HCV group was significantly lower (3278.3 ± 462.0 vs 3105.1 ± 459.4 gms; P = 0.006), and the mean head circumference was smaller (33.3 ± 0.6 vs 33.1 ± 0.7 cm; P = 0.03). In a multivariate model, HCV-infected mothers were more likely to suffer anemia [adjusted odds ratio (OR): 18.1, 95% confidence interval (CI): 4.3-76.6], require caesarian sections (adjusted OR: 2.6, 95%CI: 1.4-4.9), and have nuchal cords (adjusted OR: 5.6, 95%CI: 2.4-13.0). Their neonates were also more likely to have smaller head circumferences (adjusted OR: 2.1, 95%CI: 1.1-4.3) and lower birth weights than the average (≤ 3250 gms) with an adjusted OR of 2.2 (95%CI: 1.2-4.0). The vertical transmission rate was 1% in HCV-infected mothers.

CONCLUSION

Maternal HCV infections may associate with pregnancy and obstetric complications. We demonstrated a previously unreported association between maternal HCV viremia and a smaller neonatal head circumference, suggesting fetal growth restriction.

Keywords: Hepatitis C virus viremia, Mother-to-child transmission, Pregnancy complications, Maternal health, Infant hepatitis C virus infection

Core Tip: Although hepatitis C virus (HCV) affects a significant number of pregnant women, there is limited data regarding the impact of HCV active infection on pregnancy and infant outcomes. The current cohort study compared maternal complications and fetal development of HCV mothers with detectable levels of HCV RNA with those of healthy mothers. The study demonstrates a previously unreported association between maternal HCV viremia and a smaller neonate head circumference. In addition, HCV viremia was an independent predictor for negative maternal outcomes including anemia during pregnancy, medical conditions that required caesarian section, and nuchal cords. These findings increase the need for close antenatal surveillance in HCV mothers with viremia for maternal complications and delayed fetal development.