Burden of HCV infection among pregnant women with assessment of risk factors and pregnancy outcome in HCV infected: A hospital based study from Uttarakhand

Title: Burden of HCV infection among pregnant women with assessment of risk factors and pregnancy outcome in HCV infected: A hospital based study from Uttarakhand

Authors: Purnima Upreti, Rajesh Kumar Singh, Vandna Arya

DOI: https://dx.doi.org/10.18535/jmscr/v5i1.159

Abstract

Introduction: Hepatitis-C is a global health problem. Risk factors for HCV infection include intravenous drug use, transfusion of infected blood or blood products, unsafe therapeutic injections and surgical, dental procedures with improperly sterilized instruments. With rising incidence of HCV infection, a significant number of pregnant women are getting affected. However, there is little research regarding the burden and impact of HCV infection on pregnancy.

Aim and Objectives: The aim of the study was to evaluate burden and impact of HCV infection among pregnant women in a tertiary care centre of Uttarakhand. The objectives were to find out seroprevalence of Hepatitis-C among pregnant women, study the socio-demographic profile and risk factor profile of anti HCV positive pregnant women, to study the pregnancy outcome in anti HCV pregnant women and evaluate the need for universal antenatal screening for HCV infection.

Material and Methods: A retrospective hospital record based study of all pregnant women delivered in Dr. Sushila Tiwari Government Hospital, Haldwani between January 2014 and December 2015 was carried out. . All the pregnant women coming to the hospital are routinely screened for HCV infection as per standard protocol of the hospital. HCV status of all delivered patients was studied. A predesigned semi-structured proforma was used for collecting information regarding socio-demographic variables, risk factors and pregnancy outcome among anti-HCV positive women. Data collected was entered in MS excel and analyzed using Epi-info.

Result: Seroprevalence of Hepatitis-C among pregnant women was 0.89% in our study Among the risk factors studied, previous surgery and blood transfusion were found to be the important risk factors observed in16(25.80%) and 5(8.06%) of anti- HCV positive pregnant women. About 42 % of women had no identifiable risk factors. Pre term delivery was found to be the most common complication (33.8%) among the anti- HCV positive women. This was followed by Fetal Distress (14.51%), Pregnancy Induced Hypertension (P.I.H.), Ante- Partum Haemorrhage (A.P.H.) and Intra Uterine Fetal Death (11.29% each). About one -third of neonates (33.87%) born to anti-HCV positive mothers were premature at birth and 37.09% of neonates had low birth weight.

Conclusion: Incidence of HCV infection is on the rise. HCV infection in pregnant women is associated with several adverse maternal and neonatal outcomes. Universal screening of all pregnant women should be done for HCV infection as at risk screening may miss significant proportion of pregnant women with HCV infection.

Keywords: Hepatitis C virus, Seroprevalence, Risk Factors, Pregnancy Outcome.

References

1. Baldo V, Baldovin T, Trivello R, et al. Epidemiology of HCV infection Curr Pharm Des. 2008;14:1646-54

2. Mukhopadhya A. HCV in India. J Biosci. 2008; 33:465–473. [PubMed]

3. Sievert W, Altraif I., Razavi H.A. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int. 2011;31(suppl 2):61–80.[PubMed]

4. Ward C, Tudor-Williams G, Cotzias T, et al. Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing. Gut. 2000;47(2):277–80

5. Silverman NS, Jenkin BK, Wu C, et al. Hepatitis C virus in pregnancy: seropre-valence and risk factors for infection. Am J Obstet Gynecol. 1993; 169:583–7.

6. Parthiban R., Shanmugam S., Velu V.et al. Transmission of hepatitis C virus from asymptomatic mother to child in southern India. Int J Infect Dis. 2009;13:e394–e400.[PubMed]

7. Kumar A., Sharma A., Gupta R.K., Kar P., Chakravarti A. Prevalence & risk factors for hepatitis C virus among pregnant women. Indian J Med Res.2007; 126:211–215. [PubMed]

8. Sood A., Midha V., Bansal M., Sood N., Puri S., Thara A. Perinatal transmission of hepatitis C virus in northern India. Indian J Gastroenterol. 2012;31:27–29.[PubMed]

9. Conte D, Fraquelli M, Prati D, et al. Prevalence and clinical course of chronic hepatitis C virus (HCV) and rate of vertocle transmission in a cohort of 15,250 pregnant women. Hepatology. 2000; 31:751–5.

10. ACOG Educational Bulletin. Viral hepatitis in pregnancy. Number 248, July 1998. American college of obstetricians and gynecologists. Int J Gynaecol Obstet. 1998; 63:195–202.

11. Rawat, V.; Bhatt, U.; Singhai, M.; Kumar, A.; Malik, Y. P. S.Prevalence of hepatitis C virus infection among blood donors of Kumaon region of Uttarakhand Indian Journal of Medical Microbiology;Jul2013, Vol. 31 Issue 3, p313

12. BhawnaSethi, Satish Kumar, KS Butola, JP Mishra and Yogesh Kumar Seroprev-alence pattern among blood donors in a tertiary health care center Internet Journal of Medical Update. 2014 Jan; 9(1):10-15

13. Shaikh, F., Syed Qaiser, H.N., Kousar, J.,Allah Dino Memon, R. 2009.Prevalence and risk factors for hepatitis c virus during pregnancy. Gomal. J.Med. Sci., 2: 86- 88

14. GoyalLajya Devi • KaurSharanjit • Jindal Neerja•KaurHarpreet HCV and Pregnancy: Prevalence, Risk Factors, and Pregnancy Outcome in North Indian Population: A Case–Control Study. The Journal of Obstetrics and Gynecology of India. Oct 2014; 64(5)

15. PankajPuri,Anil C. Anand,Vivek A. Saraswat et al.Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part I: Status Report of HCV Infection in IndiaJ ClinExpHepatol. 2014 Jun; 4(2): 106–116.

16. Centers for Disease Control and Preve-ntion, Recommendations for preve-ntion and control of hepatitis C virus (HCV) infection and HCV-related disease. Morb Mortal Wkly Rep 1998; 47: 1-39.

17. Wasley AD, Alter MJ. Epidemiology of hepatitis C. Semin Liver Dis 2000; 20:1-16.

18. Stevens CE, Taylor PE, Pindyck J, Choo QL, Bradley DW,Kuo G, et al. Epidemiology of hepatitis C virus: A preliminary study in voluntary blood donors. JAMA 1990; 263: 49-53.

19. Reid S. estimating the burden of disease from unsafe injections in India: a cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence. Indian J Community Med. 2012; 37:89–94. [PubMed]

20. Jaffery T, Tariq N, Ayub R, et al. Frequency of hepatitis C in pregnancy and pregnancy outcome. J Coll Physicians Surg Pak. 2005;15:716–79

21. Jadoon HA, Ahmed Z. Prevalence of anti-HCV in blood donors of hazara (NWFP) Pakistan. J Med Res 1999; 38: 7-9.

22. Ward C, Tudor-Williams G, Cotzias T, Hargreaves S, ReganL, Foster G R. Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing. Gut 2000;47 : 277-80

23. National Institutes of Health Consensus Development Conference statement: ma-nagement of hepatitis C: 2002: June10-12, 2002. Hepatology. 2002; 36(S1): S3–S20.

24. Zanetti AR, Tanzi E, Newell M-L. Mot-her-to-infant transmission of hepatitis C virus. J Hepatol1999; 31 (Suppl1) : 96-100

25. Deborah Money, MD, FRCSC,1,2 Isabelle Boucoiran, MD, MSc,1,2 Emily Wagner, MSc,2 Simon Dobson, MD, MBBS, MRC, FRCPC,3 Aaron Kennedy, MD, MSc,1 Zoe Lohn, MSc,2Mel Krajden, MD, FRCPC,4 Eric M. Yoshida, MD, FRCPC, MHSc5 Obstetrical and Neonatal Outcomes Among Women Infected With Hepatitis C and Their Infants J Obstet Gynaecol Can 2014;36(9):785–794

26. Connell LE, Salihu HM, Salemi JL, August EM, Weldeselasse H, Mbah AK. Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver Int 2011; 31(8):1163–70

27. Berkley EM, Leslie KK, Arora S, Qualls C, Dunkelberg JC. Chronic hepatitis C in pregnancy. Obstet Gynecol 2008; 112(2 Pt 1):304–10.

28. Hillemanns P, Dannecker C, Kimmig R, Hasbargen U. Obstetric risks and vertical transmission of hepatitis C virus infection in pregnancy. ActaObstetGynecolScand 2000; 79(7):543–7.

29. Pergam SA, Wang CC, Gardella CM, Sandison TG, Phipps WT, Hawes SE. Pregnancy complications associated with hepatitis C: data from a 2003–2005 Washington state birth cohort. Am J ObstetGynecol 2008; 199(1):38.e1–38.e9.

30. Reddick KL, Jhaveri R, Gandhi M, James AH, Swamy GK. Pregnancy outcomes associated with viral hepatitis. J Viral Hepat 2011; 18(7):e394–8.

31. Medhat A, el-Sharkawy MM, Shaaban MM, et al. Acute viral hepatitis in pregn-ancy. Int J GynaecolObstet 1993;40:25-31

32. Bohman VR, Stettler RW, Little BB, et al. Seroprevalence and risk factors for hepat-itis C virus antibody in pregnant women. Obstet Gynecol1992; 80:609-13.

33. Latt NC, Spencer JD, Beeby PJ, et al. Hepatitis C in injecting drug-using women during and after pregnanc. J Gastroenterol Hepatol 2000; 15:175-81.

34. Redline RW. Severe fetal placental vascularlesions in term infants with neurologic impairment. Am J Obstet Gynecol 2005; 192:452-7.

35. Sander CM, Gilliland D, Akers C, et al. Live births with placental hemorrhagic endovasculitis: Interlesional relationships and perinatal outcomes. Arch Pathol Lab Med 2002;126:157-64

36. Marti C, Pena JM, Bates I, et al. Obstetric and perinatal complications in HIV—infected women. Analysis of cohort of 167 pregnancies between 1997 and 2003. Acta Ostet Gynecol Scand. 2007;86(4):409–15

37. Jabeen T, Cannon B, Hogan J, et al. Pregn-ancy and pregnancy outcome in hepatitis C type 1b. QJM. 2000;93:597–601

38. American College of Obstetricians and Gynecologists. Primary and preventive care: Periodic assessments. ACOG tech-nical bulletin no. 246. Washington (DC): American College of Obstetricians and Gynecologists; 2000. p. 1-7.

39. Plunkett BA, Grobman WA. Routine hepatitis C virus screening in pregnancy: A cost-effectiveness analysis. Am JObstetGynecol2005;192:1153-61

40. Boaz K, Fiore AE, Schrag SJ, et al. Screening and counseling practices reported by obstetrician-gynecologists for patients with hepatitis C virus infection. Infect Dis ObstetGynecol 2003; 11:39-44.

41. Giles ML, Sasadeusz JJ, Garland SM, et al. An audit of obstetricians’ management of women potentially infected with blood-borne viruses. Med J Aust 2004;80:328-32

42. Floreani A, Paternoster D, Zappala F, et al.Hepatitis C virus infection in pregnancy. Br J ObstetGynaecol 1996;103:325-9.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles