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Combined HCV, opioid use disorder increasing among pregnant women

The rates of hepatitis C infection at delivery among pregnant women in the U.S. increased between 2000 and 2015, especially among women with concomitant opioid use disorder, the prevalence of which also increased during that period.

Increases in HCV among both the general U.S. population and pregnant women during the last decade have correlated with the opioid epidemic, according to Jean Y. Ko, PhD, from the National Center for Chronic Disease Prevention and Health Promotion at the CDC, and colleagues, as approximately 68% of pregnant women with HCV have opioid use disorder.

“Current U.S. Preventive Services Task Force and CDC guidelines recommend hepatitis C testing for persons at high risk (eg, persons who inject drugs); however, epidemiologic changes in HCV infection in the United States have prompted a review of the evidence informing HCV testing,” they wrote. “Treatment of opioid use disorder should include screening and referral for related conditions such as HCV infection.”

According to hospital discharge data from 2000 to 2015, the rates of HCV infection in pregnant women increased by 0.8 per (95% CI, 0.7-0.9) to 4.1 (95% CI, 3.7-4.4) per 1,000 deliveries.

During this period, HCV rates among women without opioid disorders increased by 0.7 (95% CI, 0.6-0.8) to 2.6 (95% CI, 2.4-2.9) per 1,000 deliveries, whereas infection rates among those with opioid use disorder increased from 87.4 (95% CI, 56.3-118.5) to 216.9 (95% CI, 197.9-235.9) per 1,000 deliveries

In 2015, Ko and colleagues found that all three categories of women — those with HCV only, opioid use disorder only, and both HCV and opioid use disorder — shared similar risk factors.

Compared with women aged 35 years or older, those aged between 25 years and 34 years were more likely to have HCV (OR = 1.2; 95% CI, 1-1.4), opioid use disorder (OR = 1.8; 95% CI, 1.6-2), or both (OR = 1.8; 95% CI, 1.4-2.3) at delivery.

Other factors that increased the likelihood of HCV, opioid use disorder, or both included publicly billed deliveries compared with privately billed deliveries and median income of less than $42,000 compared with a median income of $68,000 or higher.

Compared with residents from the Western census region of the U.S., women from the South were more likely to have HCV at delivery (OR = 1.9; 95% CI, 1.5-2.3) while women from the Northeast had the highest likelihood for opioid use disorder (OR = 2; 95% CI, 1.6-2.4) or both HCV and opioid use disorder at delivery (OR = 4.8; 95% CI, 3.1-7.5).

“Although treatment of HCV infection with direct-acting antiviral agents during pregnancy is not approved, testing remains important to identify infections, engage infected women in postpartum treatment, and identify infants who might have been exposed,” Ko and colleagues concluded. “Left untreated, HCV infection might lead to cirrhosis and pose continued risk to others through parenteral exposures (eg, injection drug use or transmission via subsequent pregnancies).” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.