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HCV in Pregnancy Increased 10-Fold - Deliveries Among Patients With Maternal Hepatitis C Virus Infection in the United States, 2000-2019
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Download the PDF here
Arditi, Brittany MD, MSCR; Emont, Jordan MD, MPH; Friedman, Alexander M. MD, MPH; D'Alton, Mary E. MD; Wen, Timothy MD, MPH
April 2023
OBJECTIVE:
To assess clinical characteristics, trends, and outcomes associated with the diagnosis of hepatitis C virus (HCV) infection during pregnancy.
METHODS:
This cross-sectional study analyzed delivery hospitalizations using the National Inpatient Sample. Temporal trends in both diagnosis of HCV infection and clinical characteristics associated with HCV infection were analyzed using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Survey-adjusted logistic regression models were fit to assess the association among HCV infection and preterm delivery, cesarean delivery, and severe maternal morbidity (SMM), adjusting for clinical, medical, and hospital factors with adjusted odds ratios (aORs) as the measure of association.
RESULTS:
An estimated 76.7 million delivery hospitalizations were included, in which 182,904 (0.24%) delivering individuals had a diagnosis of HCV infection.
The prevalence of HCV infection diagnosed in pregnancy increased nearly 10-fold over the study period, from 0.05% in 2000 to 0.49% in 2019, representing an AAPC of 12.5% (95% CI 10.4-14.8%).
The prevalence of clinical characteristics associated with HCV infection also increased over the study period, including opioid use disorder (from 10 cases/10,000 birth hospitalizations to 71 cases/10,000 birth hospitalizations), nonopioid substance use disorder (from 71 cases/10,000 birth hospitalizations to 217 cases/10,000 birth hospitalizations), mental health conditions (from 219 cases/10,000 birth hospitalizations to 1,117 cases/10,000), and tobacco use (from 61 cases/10,000 birth hospitalizations to 842 cases/10,000).
The rate of deliveries among patients with two or more clinical characteristics associated with HCV infection increased from 26 cases per 10,000 birth hospitalizations to 377 cases per 10,000 delivery hospitalizations (AAPC 13.4%, 95% CI 12.1-14.8%).
In adjusted analyses, HCV infection was associated with increased risk for SMM (aOR 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).
CONCLUSION:
Diagnosis of HCV infection is increasingly common in the obstetric population, which may reflect an increase in screening or a true increase in prevalence. The increase in HCV infection diagnoses occurred in the setting of many baseline clinical characteristics that are associated with HCV infection becoming more common.
Hepatitis C virus (HCV) infection is becoming increasingly prevalent in pregnancy. An analysis of U.S. natality data found that the prevalence of maternal HCV infection increased 161% from 2009 to 2017.1 In 2019, more than 60% of acute HCV infection cases reported to the Centers for Disease Control and Prevention were among patients aged 20-39 years.2 Given this increasing prevalence among patients of reproductive age, the CDC recommended universal screening for HCV infection in 2020, which was formally endorsed by the American College of Obstetricians and Gynecologists in 2021.3
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.4 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.
Similarly, there is a knowledge gap with regards to obstetric outcomes among patients with HCV infection. The existing literature shows mixed results, with some studies demonstrating an association between HCV infection and poor obstetric outcomes and others supporting no such risks.5-10 Additionally, there is a paucity of literature with regards to the association of HCV infection with severe maternal morbidity (SMM). In this study, our objectives were to 1) evaluate temporal trends in the diagnosis of HCV infection in pregnancy and clinical characteristics previously associated with HCV infection over a 20-year period (2000-2019) and 2) analyze maternal outcomes at delivery hospitalization among patients with a diagnosis of HCV infection.
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