Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus.

Objective To investigate the effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. Design Pooled retrospective analysis of prospectively collected data. Sample Data on hepatitis C virus seropositive mothers and their children identi®ed around delivery were sent from 24 centres of the European Paediatric Hepatitis C Virus Network. Main outcome measures Hepatitis C virus infection status of children born to hepatitis C virus infected women. Results A total of 1,474 hepatitis C virus infected women were identi®ed, of whom 503 (35%) were co-infected with HIV. Co-infected women were more than twice as likely to transmit hepatitis C virus to their children than women with hepatitis C virus infection alone. Overall 9.2% (136/1474) of children were hepatitis C virus infected. Among the women with hepatitis C virus infection-only, multivariate analyses did not show a signi®cant effect of mode of delivery and breastfeeding: caesarean section vs vaginal delivery OR ˆ 1.17, P ˆ 0.66; breastfed versus non-breastfed OR ˆ 1.07, P ˆ 0.83. However, HIV co-infected women delivered by caesarean section were 60% less likely to have an infected child than those delivered vaginally (OR ˆ 0.36, P ˆ 0.01) and those who breastfed were about four times more likely to infect their children than those who did not (OR ˆ 6.41, P ˆ 0.03). HIV infected children were three to four times more likely also to be hepatitis C virus infected than children without HIV infection (crude OR ˆ 3.76, 95% CI 1.89±7.41). Conclusions These results do not support a recommendation of elective caesarean section or avoidance of breastfeeding for women with hepatitis C virus infection only, but the case for HIV infected women undergoing caesarean section delivery and avoiding breastfeeding is strengthened if they are also hepatitis C virus infected.