Hepatitis C diagnosis increasing among pregnant women

Key takeaways :

• From 2000 to 2019, the average annual percent change was 12.5% in HCV prevalence in pregnancy.
• Identifying and treating women at high risk for infection before pregnancy may be important in optimizing care.

Hepatitis C virus among the U.S. obstetric population rose nearly 10-fold over 20 years, which might reflect an increase in screening or prevalence, according to researchers.

“The opioid epidemic and resultant increasing rates of intravenous drug use are thought to account for a large proportion of the rising incidence of HCV infection. However, 50% of individuals with HCV infection report no history of intravenous drug use,” Brittany Arditi, MD, MSCR, resident physician in the department of obstetrics and gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center, and colleagues wrote. “As such, there is a knowledge gap with regards to other risk factors, demographic and clinical characteristics, and comorbidities associated with HCV infection among pregnant patients.”

Researchers analyzed data o 76.7 million delivery hospitalizations using the National Inpatient Sample and assessed trends in both diagnosis of HCV infection and clinical characteristics associated with the infection.

Overall, 182,904 delivering women had an HCV infection diagnosis. There was a nearly 10-fold increase in the prevalence of HCV diagnosed in pregnancy, from 0.05% in 2000 to 0.49% in 2019, which came out to an average annual percent change of 12.5%. In addition, researchers observed an increase from 2000 to 2019 in the prevalence of clinical characteristics per 10,000 birth hospitalizations associated with HCV infection: opioid use disorder (10 vs. 71), nonopioid substance use disorder (71 vs. 217), mental health conditions (219 vs. 1,117) and tobacco use (61 vs. 842).

Researchers also noted an increase during the study period in the rate of deliveries among women with two or more clinical characteristics associated with HCV, rising from 26 to 377 cases per 10,000 birth hospitalizations, which resulted in an average annual percent change of 13.4%.

HCV was also associated with an increased risk for severe maternal morbidity (adjusted OR = 1.78; 95% CI, 1.61-1.96), preterm birth (aOR = 1.88; 95% CI, 1.8-1.95) and cesarean delivery (aOR = 1.27; 95% CI, 1.23-1.31).

“These findings support universal screening for HCV infection in pregnancy and that, identifying and treating women at high risk for infection before pregnancy may be an important focus for optimizing care and mitigating perinatal HCV transmission,” the researchers wrote.