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Author Credentials

Kelly Cummings MD Jesse Cottrell MD Songthip Ounpraseuth PhD Ryan Stone MD David G. Chaffin MD Everett Magann MD

DOI

http://dx.doi.org/10.18590/mjm.2018.vol4.iss2.8

Abstract

Hepatitis C (HCV) is a common form of liver disease encountered in pregnancy. The purpose of this study is to evaluate if hepatitis C is associated with elevated maternal serum bile acids and abnormal fetal cardiac function measured by the left ventricular Tei index in the absence of intrahepatic cholestasis of pregnancy. This is a prospective cohort study on pregnant women with hepatitis C seen through Marshall University’s high-risk obstetrics clinic from 2013 to 2014. Women with hepatitis C had a laboratory evaluation and an ultrasound on the fetus to calculate the left ventricular Tei index. Demographic information and delivery outcomes were recorded. There were 77 participants with hepatitis C recruited and consented for this study. Sixty-one participants had complete laboratory and delivery information available for analysis. Twenty-one participants had a viral load that was not detectable and 40 participants had a detectable viral load. The mean viral load overall was 1943771 IU/mL (SD 4257143). There was no difference in Tei index between detectable and non-detectable viral load, 0.41 and 0.38 respectively (p = 0.41). There was no statistical difference in bile acid level between detectable and undetectable viral load, 12 and 8 µmol/L respectively (p = 0.05). Hepatic liver disease manifested by elevated hepatitis C viral load or elevated bile acids did not affect the left ventricular Tei index.

Conflict(s) of Interest

N/A

References with DOI

1. Beste LA, Bondurant HC, Ioannou GN. Prevalence and management of chronic hepatitis C virus infection in women. Med Clin North Am. 2015;99(3):575-86. https://doi.org/10.1016/j.mcna.2015.01.009

2. Zibbell JE, Iqbal K, Patel RC, Suryaprasad A, Sanders KJ, Moore-Moravian L, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged

3. Chevaliez S, Pawlotsky JM. HCV Genome and Life Cycle. In: Tan SL, editor. Hepatitis C Viruses: Genomes and Molecular Biology. Norfolk (UK)2006.

4. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 2015;62(5):1353-63. https://doi.org/10.1002/hep.27978

5. Webster DP, Klenerman P, Dusheiko GM. Hepatitis C. Lancet. 2015;385(9973):1124-35. https://doi.org/10.1016/s0140-6736(14)62401-6

6. Rolls DA, Sacks-Davis R, Jenkinson R, McBryde E, Pattison P, Robins G, et al. Hepatitis C Transmission and Treatment in Contact Networks of People Who Inject Drugs. Plos One. 2013;8(11). https://doi.org/10.1371/journal.pone.0078286

7. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998;47(RR-19):1-39. https://doi.org/10.1037/e547602006-001

8. American College of O, Gynecologists. ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol. 2007;110(4):941-56. https://doi.org/10.1097/01.aog.0000263930.28382.2a

9. Prasad MR, Honegger JR. Hepatitis C virus in pregnancy. Am J Perinatol. 2013;30(2):149-59. https://doi.org/10.1055/s-0033-1334459

10. Money D, Boucoiran I, Wagner E, Dobson S, Kennedy A, Lohn Z, et al. Obstetrical and neonatal outcomes among women infected with hepatitis C and their infants. J Obstet Gynaecol Can. 2014;36(9):785-94. https://doi.org/10.1016/s1701-2163(15)30480-1

11. CDC. West Virginia - 2015 State Health Profile 2015 [cited 2016 July 17]. Available from: https://www.cdc.gov/nchhstp/stateprofiles/pdf/west_virginia_profile.pdf.

12. Beuers U, Pusl T. Intrahepatic cholestasis of pregnancy--a heterogeneous group of pregnancy-related disorders? Hepatology. 2006;43(4):647-9. https://doi.org/10.1002/hep.21156

13. Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol. 1988;95(11):1137-43. https://doi.org/10.1111/j.1471-0528.1988.tb06791.x

14. Alsulyman OM, Ouzounian JG, Ames-Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. American journal of obstetrics and gynecology. 1996;175(4 Pt 1):957-60. https://doi.org/10.1016/s0002-9378(96)80031-7

15. Belay T, Woldegiorgis H, Gress T, Rayyan Y. Intrahepatic cholestasis of pregnancy with concomitant hepatitis C virus infection, Joan C. Edwards SOM, Marshall University. Eur J Gastroenterol Hepatol. 2015;27(4):372-4. https://doi.org/10.1097/meg.0000000000000293

16. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26(6):357-66.

17. Lakoumentas JA, Panou FK, Kotseroglou VK, Aggeli KI, Harbis PK. The Tei index of myocardial performance: applications in cardiology. Hellenic J Cardiol. 2005;46(1):52-8.

18. Henry A, Welsh AW. Monitoring intrahepatic cholestasis of pregnancy using the fetal myocardial performance index: a cohort study. Ultrasound Obstet Gynecol. 2015;46(5):571-8. https://doi.org/10.1002/uog.14769

19. Zhang LJ, Xiang H, Ding YL. [Influence of total bile acid in maternal serum and cord blood on neonatal cardiac function from intrahepatic cholestasis of pregnancy]. Zhonghua Fu Chan Ke Za Zhi. 2009;44(3):188-90.

20. Cummings K, Stone R, Chaffin D. How Does the TEI Indice Correlate with Bile Acid Levels in Women with Intrahepatic Cholestasis of Pregnancy? Reproductive Sciences. 2013;20(S3):282a-a.

21. Eidem BW, Edwards JM, Cetta F. Quantitative assessment of fetal ventricular function: establishing normal values of the myocardial performance index in the fetus. Echocardiography. 2001;18(1):9-13. https://doi.org/10.1046/j.1540-8175.2001.t01-1-00009.x

22. Chambers J, Tuson A. Scratching can reveal more than just an itch. Pract Midwife. 2011;14(9):30-3.

23. Women ACoHCfU, American Society of Addiction M. ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol. 2012;119(5):1070-6. https://doi.org/10.1097/aog.0b013e318256496e

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