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 id
entified around delivery were sent from 24 centres of the European Paediatr
ic Hepatitis C Virus Network.
Main outcome measures Hepatitis C virus infection status of children born t
o hepatitis C virus infected women.
Results A total of 1,474 hepatitis C virus infected women were identified,
of whom 503 (35%) were co-infected with HIV. Go-infected women were more th
an twice as likely to transmit hepatitis C virus to their children than wom
en with hepatitis C virus infection alone. Overall 9.2% (136/1474) of child
ren were hepatitis C virus infected. Among the women with hepatitis C virus
infection-only, multivariate analyses did not show a significant effect of
mode of delivery and breastfeeding: caesarean section is vaginal delivery
OR = 1.17: p = 0.661 breastfed versus non-breastfed OR = 1.07, P = 0.83. Ho
wever, HIV co-infected women delivered by caesarean section were 60% less l
ikely to have an infected child than those delivered vaginally (OR 0.36, p
= 0.01) and those who breastfed were about four times more likely to infect
their children than those who did not (OR = 6.41, P = 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 = 3.76, 95% CI 1.89-
Conclusions These results do not support a recommendation of elective caesa
rean section or avoidance of breastfeeding for women with hepatitis C virus
infection only, but the case for HIV infected women under,going caesarean
section delivery and avoiding breastfeeding is strengthened if they are als
o hepatitis C virus infected.