The Reproductive Care of Women Living With Hepatitis C Infection

II. Introduction

Hepatitis C virus (HCV), which was first discovered in 1989, is an important cause of chronic liver disease and is increasingly recognized as a major public health problem worldwide. It is a bloodborne pathogen and is the most frequent etiology necessitating liver transplantation, producing considerable costs to health care systems. It has been estimated that three percent of the world population is currently infected with HCV.¹ The estimated prevalence in Canada is 0.8 percent, suggesting a total number of 240,000 infected persons (Table I).²Only about 30 percent of those infected with HCV are thought to be aware of their infection. Extrapolation from the general population data in Canada would suggest that up to one in 120 deliveries might occur in an infected woman. The incidence is rising most rapidly in the 20 to 45 year age group, implying that HCV will be seen more and more commonly in women of childbearing years.

HCV is responsible for considerable morbidity and mortality, with the majority of acute infections becoming chronic.³ It represents the most common cause of chronic viral and posttransfusion hepatitis, although in Canada the risk of this has fallen to almost nil since 1990 with the introduction of screening, and ranks only slightly below chronic alcohol use as a cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma.3 Vertical transmission occurs with variable frequency dependent on the existence of co-factors and other medical conditions.^4,5,6,7 Nosocomial infection has been reported in both patients and health care workers. HCV has a huge impact on the family unit in psychological and social terms, but will also raise specific issues for women regarding contraceptive choices, pregnancy, assisted reproduction, and hormone replacement therapy.

The issues for those providing health care to women of childbearing age are several: identification of at-risk patients

Figure 1 : Prevalence of HCV in Different Parts of the World

Source: CCDR 2000;26(5).March 2000. *Based on published data. - Provenant d'Ètudes publishÈes.

and provision of appropriate screening; evidence based counselling regarding the complex issues related to pregnancy, including vertical transmission and therapy; patient education; and psychological support of the identified patient and her family prior to, during, and after the pregnancy.

The following guideline has been developed to inform, educate, and prepare the health care community to identify and counsel women living with HCV.

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