Less than half of infants born to women with HCV, cirrhosis screened for HCV

Despite guidelines to ensure proper screening, one study presented during the Liver Meeting Digital Experience showed only 42% of infants born to women with hepatitis C and cirrhosis are screened and followed for hepatitis C.

“We have seen in some health systems within the U.S. that infants are rarely followed up appropriately and receive the correct testing for hepatitis C and linkage to care as a result. Therefore, many infants born to moms with hepatitis C are left undiagnosed and uncared for,” Tatyana Kushner, MD, MSCE, assistant professor of medicine at Icahn School of Medicine at Mount Sinai, said in her press conference presentation. “We really need to identify or develop ways to improve adherence to testing guidelines both in the mother but as well as in terms of engaging mothers and health care providers to make sure infants receive the appropriate testing.”

Kushner and colleagues conducted a population-based retrospective cohort study using a database in Ontario, Canada. The database included more than 14 million people, from which the researchers identified women who were diagnosed with HCV and cirrhosis who also gave birth from 2000 to 2014. They found 195 births from 151 women.

“This is not a very common thing. We don’t see that many women who develop cirrhosis from hepatitis C by the time they are pregnant or in childbearing age. However, it is important that there are women that do and those women, you would suspect, would have the closest vigilance both for them as well as their infants,” Kushner said. “Importantly, many women were only diagnosed with hepatitis C during pregnancy. In our cohort, 26% ... were initially diagnosed with hepatitis C during pregnancy. Similarly, many women – about 17% – were diagnosed with cirrhosis in pregnancy. That demonstrates that pregnancy is a really critical time for making these liver disease diagnoses.”

The findings also showed that women with HCV and cirrhosis were relatively more likely to experience pregnancy complications. Kushner said 5% had a complication with intrahepatic cholestasis of pregnancy, which was linked to adverse fetal outcomes; 37% underwent c-section; 19% had pre-term delivery and more than 20% were small or large for gestational age.

In looking at the follow-up after delivery, only 42% of the infants were tested for HCV at any point and only 39% of clinicians followed optimal screening recommendations.

“More than half of infants did not have any hepatitis C testing at all,” Kushner said. “These are infants born to mothers with cirrhosis so these are infants who you would think – due to advanced disease in their mothers – would have closer follow up.”

Kushner noted that although the USPSTF and CDC both came out this year to recommend universal screening for HCV in pregnancy, it is studies like this that demonstrate the importance of this time period for women’s health and, in this study, also indicated better care for the infants.

“It’s a critical time when women are engaged in care and can be linked for follow up,” she said. “If women were diagnosed with hepatitis C during pregnancy, their infants would be significantly more likely to get the appropriate screening. That demonstrates, again, the opportunity to screen for hepatitis C during pregnancy and diagnose hepatitis C during pregnancy may also beneficially impact appropriate infant follow up.”