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
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
Cummings, Kelly; Cottrell, Jesse; Ounpraseuth, Songthip; Stone, Ryan; Chaffin, David G.; and Magann, Everett
"The Effect of Hepatitis C on Maternal Bile Acid Level and the Fetal Left Ventricular Tei Index,"
Marshall Journal of Medicine:
2, Article 8.
Available at: https://mds.marshall.edu/mjm/vol4/iss2/8