Although Egypt is an endemic country to both viral hepatitis C (HCV) and B (HBV) infections, there is limited data on their related burden among pregnant women. In the current study, we aimed to assess the prevalence of chronic HCV and HBV in a cohort of pregnant Egyptian females highlighting the disease burden for better preventive measures.
Results of the current study revealed prevalence rates of HCV-Ab and HBsAg positivity of 7.02% and 7.52% respectively. Isolated HBcAb positivity was found in only 2 patients (0.5%). All cases were negative for HBsAb. No combined HBV/HCV infection was detected.
HCV Ab prevalence among pregnant females in the current study (7.02%) matches with the general prevalence of HCV in 2015 Egyptian Health Issues Survey (HIS) for females aged 15-59 years who had HCV antibody and HCV-RNA prevalence rates of 8.1% and 5.5% respectively . On the other side, it is higher than the rate of HCV Ab positivity found in the systematic review and meta-analysis conducted by Binga and collaegues in 2019 to determine the magnitude of HCV and HBV infections among pregnant women living in 30 countries in Africa; they reported a pooled prevalence rate of 3.4% for HCV Ab positivity and 6.8% for HBsAg positivity . High prevalence rate in our study may be explained by the findings that 42.8% of HCV Ab positive females had rural residence, and 46.41% of them had previous pregnancy-related complications including miscarriage and still birth, also 7.14% of them had history of previous operations. In such situations (miscarriage, stillbirth, previous operations), poor implementation of infection control measures in the hospital and especially in the operation rooms and lack of awareness about transmission of these blood born viral infections may contribute to the higher transmission and prevalence rates. This finding necessitates application of strong awareness and screening programs for females in childbearing period prior to marriage or conception to offer treatment with direct acting antiviral therapy with high efficacy and tolerability to avoid risk of vertical transmission and for better maternal outcomes.
In the current study, HBsAg positivity rate (7.52%) is much higher than that detected in 2015 Egyptian Health Issues Survey (HIS) for females aged 15-59 years who had prevalence rate of 1.2% for HBsAg . It is also much higher than the pooled prevalence found in a systematic review and meta-analysis conducted on the frequency of HBsAg in pregnant women from Eastern Mediterranean and Middle Eastern countries by Malekifar and colleagues in 2018, where pooled prevalence in pregnant Egyptian females was 3.2% . This higher rate may reflect lack of awareness and poor compliance of these females to the compulsory HBV vaccination in their childhood especially that 54.89% of them were from rural areas with poor socioeconomic conditions. It also gives insight on the mandatory screening for HBV in pregnant females even with the nationwide application of vaccination programs to save the newborns from getting HBV infected via vertical transmission with application of proper preventive measures including immunoglobulin administration and HBV vaccination of the newborn in the first few hours of his life according to the most recent guidelines .
It appears that women in child-bearing period (CBP) have a slower rate of disease progression in viral hepatitis than men and postmenopausal females . This may be attributed to the protective effect of estrogen in females of the CBP. Estrogen in the liver seems to protect the hepatocytes from inflammatory injury, oxidative stress, and cell death . In the current study, no significant difference was found between HCV positive and negative cases as regards liver enzymes. And although ALT was significantly higher among HBV positive versus negative patients, all values were within normal ranges. However, risk of disease progression increases after menopause with loss of hormonal protective effects .
Main limitations of our study are being in one center; however, being in a tertiary hospital, it represents a referral center for different destinations, next is the absence of confirmatory PCR results, although all positive patients were referred to specialized clinics for further follow-up for both mothers and neonates.