Hello to all,

Have just joined LACTNET (about 3 days).

My name is Anne Clarke, and I live in Brisbane, Qeensland the tropical
north of Australia.  I have been a LC for six months but I have been a
midwife for nearly 20 years (Oh God has it been that long!).

I have enjoyed all the information being presented on many subjects, and
look forward to talking and reading on LACTNET in the future.

HEP C INFO

This information comes from a paper I have just received from the Lactation
Resource Centre in Melbourne, Australia, which is run by the Nursing
Mother's Association of Australia.

The paper is by Kay Murray and is called BREASTFEEDING AND HEPATITIS C
TRANSMISSION. The paper if fairly comprehensive so I will just give you the
summary and conclusions.

This review has analysed all the available literature on mother-to-child
Hep C transmission and more specifically, Hep C transmission through
breastfeeding.  Research results have confirmed that vertical transmission
does occur (at rates betwee 0 and 10% depending on risk factors) but the
risk is much lower than other communicable diseases such as HIV.  In light
of the serious and potentially fatal nature of the virus, it is appropriate
to report on factors which appear to influence the risk of transmission.

Bearing in mind the methodological difficulties outlined, the following
factors have been shown to influence the rate of disease transmission.

        * HIV co-infection - in general, higher transmission rates have been
determined where mothers are co-infected with HCV and HIV.

        * Type of delivery - some limited evidence that vaginal deliveries carry
higher risk than caesarean births presumably due to the increased exposure
to maternal blood and the greater opportunities for mixing of foetal and
maternal blood.

        * Maternal risk factors - some evidence that injecting drug use, multiple
partners and the presence of sexually transmittable diseases increase the
risk of transmission.

        * Viral load - mothers with high levels of virus in their blood (and
possibly also in breastmilk) particularly in the acute or seroconversion
stage during pregnancy have a higher chance of transmitting HCV to their
infants.

It should be borne in mind, however, that the above factors are associated
with mother-to-child transmission only and not transmission through
breastmilk.  When all the research results are taken as a whole, only three
infants out of a total of 540 (0.5%) could be considered to have possible
indicators of transmission through breastmilk since they were the only
children whose mothers acquired the infection after their birth (i.e. from
a blood transfusion after birth).  In these cases, the babies could not
have acquired HCV in-utero or during the birth process therfore some other
transmission route must have been involved. All other investigations used
study samples of mothers infected during pregnancy or HCV+ when tested at
birth.  In these situations, it is difficult, if not impossible, to
determine the source of infection as in-utero, during the birth process or
some time thereafter.

Given the above low risk, there would seem to be little justification for
medical practitioner and other health professionals to be advising HCV
positive mothers not to breastfeed.  Although, HCV has been detected in
breastmilk, this had not been conclusively proven in all studies.  In those
few studies where breastmilk has tested positive for HCV, viral
concentrations have been shown to be considerably lower than in maternal
blood fuelling speculation that the viral load is too low to transmit the
virus effectively.  Until more definitive research is conducted, the only
valid advice would appear to be that breastfeeding carries little risk and
therefore should be encouraged in the absence of HIV co-infection.

I hope this has been of some help.

If anyone would like a list of the references Kay Murray used please let me
know.

Anne Clarke RN, RM, LC. BHSc., Grad. Dip Childbirth Ed, Crad. Cert. NP.