HCV-positive pregnancies in US increased 16-fold from 1998 to 2018

Key takeaways:

• Hepatitis C infection during pregnancy increased from 0.34 cases per 1,000 pregnancies in 1998 to 5.3 cases per 1,000 pregnancies in 2018.
• Age-specific HCV prevalence increases ranged from threefold to 31-fold.

The prevalence of maternal hepatitis C virus infection has significantly increased in the U.S. since the start of the opioid epidemic in 1998, according to results from a cross-sectional study published in JAMA Network Open.

“Given the potential for mother-to-child transmission, rising HCV infections among pregnant women likely also mean more infants born with HCV infections. HCV screening in infants born to mothers with HCV is currently recommended at 18 months old; thus, careful communication between obstetricians and pediatricians will be crucial,” Po-Hung Chen, MD, PhD, assistant professor of medicine in the division of gastroenterology and hepatology at Johns Hopkins University School of Medicine, told Healio. “HCV infection may also negatively impact pregnancy-related outcomes for the mother and child.”

Chen and colleagues analyzed data from the U.S. from 1998 to 2018 on more than 70 million hospital admissions for in-hospital childbirth, stillbirth or spontaneous abortion in the National Inpatient Sample of the Healthcare Cost and Utilization Project. All women were aged 18 to 50 years during pregnancy. Researchers identified HCV-positive admissions to evaluate the temporal trend during the opioid epidemic and identify HCV-associated maternal and perinatal outcomes.

The primary outcome was change in the annual prevalence of HCV-positive pregnancies since 1998. Secondary outcomes included associations between maternal HCV infection and maternal and perinatal adverse events.

In total, 137,259 hospital admissions for childbirth or spontaneous abortion were women with HCV (median age, 28 years). Compared with HCV-negative mothers, those with HCV were more often white (77.4% vs. 53.9%), low-income (40% vs. 26.9%) and likely to have a history of tobacco use (41.7% vs. 4%), alcohol use (1.8% vs. 0.1%) and opioid use (28.9% vs. 0.3%). Pregnant women with HCV also more often presented in rural (14% vs. 11.6%) and urban (61.1% vs. 49.8%) teaching hospitals compared with those without HCV.

From 1998 to 2018, the prevalence of HCV-positive pregnancies increased from 0.34 cases per 1,000 pregnancies to 5.3 cases per 1,000 pregnancies, which was a 16-fold increase over 21 years. HCV-positive pregnancy prevalence increased in all age groups, with a 22-fold increase among women aged 18 to 20 years, 31-fold increase among women aged 21 to 30 years, eightfold increase among women aged 31 to 40 years and threefold increase among women aged 41 to 50 years.

In addition, pregnant women with HCV had higher odds of cesarean delivery (38.6% vs. 30.2%), preterm birth (11.6% vs. 6.8%), poor fetal growth (5.7% vs. 2%) or fetal distress (20.3% vs. 15.6%) compared with pregnant women without HCV. Researchers observed no significant differences for gestational diabetes (6.6% vs. 6.2%), preeclampsia/eclampsia (4.9% vs. 4.1%) or stillbirths (1% vs. 0.7%) between the groups.

“We need additional research on the subsequent linkage to appropriate specialist care for mothers and newborns found to have HCV during universal antepartum screening,” Chen said. “How often is the referral and linkage to care currently done successfully? How do we improve the process? Do specific implementation steps need to vary depending on the clinical practice context?”

For more information:

Po-Hung Chen, MD, PhD, can be reached at pchen37@jhmi.edu.