A recent cross-sectional study of more than 70 million obstetric hospitalizations between 1998 and 2018 showed a 16-fold increase in hepatitis C infection rates during pregnancy in the United States, which has been linked to the opioid epidemic.
The researchers said they conducted this study to add to previous scarce data on HCV infection during pregnancy and to clarify conflicting reports on the role of HCV in pregnancy and perinatal outcomes.
“Given the increase in HCV infection among women of childbearing age, the risk of vertical transmission of HCV, and the potential for pregnancy-related adverse events, clinicians and policymakers need to deepen their understanding of HCV infection during pregnancy,” the study’s lead author explains. Understanding hepatitis virus infection and its impact on outcomes.” , Po-Hung Chen, MD, PhD, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and colleague.
Chen and colleagues extracted data on hospitalizations culminating in labor, stillbirth, or spontaneous abortion from the National Inpatient Sample (NIS), the largest public database of all-payer inpatient care in the United States. In this cohort, 137,259 individuals (0.20% (95% CI: 0.19-0.21)) were HCV positive.
During the 21-year study period, maternal HCV infection rates increased 16-fold, from 0.34% (10.9-12.3) per 1000 pregnant women in 1998 to 5.3% (4.9-5.7) in 2018. HCV-positive pregnancy rates increased across all age groups, but the largest increase was among women aged 21 to 30 years (31-fold). Because the earliest recommendations for HCV screening in pregnancy were not published until 2018, the researchers acknowledge that HCV prevalence may have been underestimated.
“These increases coincided with an increase in the proportion of pregnancies among women with a history of opioid use,” noted Chen and colleagues. “The increase in HCV-positive pregnancies among those aged 21 to 30 years accelerated after the onset of the second wave of the epidemic.” 2010 The opioid epidemic. “
Blood-borne HCV infections are caused by injection drug use, and acute HCV cases tripled between 2010 and 2015, the researchers explained. They describe the “second wave” of the opioid epidemic as events related to heroin overdoses that occurred between 2010 and 2013. Deaths initially dominate and transition to a “third wave” of synthetic opioid overdose deaths.
“Over the past two decades, concurrent with the opioid epidemic, hepatitis C virus infection has steadily increased among women of childbearing age,” Chen declared in a discussion of the study. infect.
“It would make sense to conduct universal HCV screening in every pregnancy. It may also make sense to devote more public health resources to addressing the opioid epidemic, although our approach cannot technically establish cause and effect. relationships,” Chen said.
Adverse events compared in the HCV-positive and -negative groups included pregnancy with anemia, gestational diabetes, pregnancy with hypertension, and pregnancy with thyroid dysfunction. Perinatal events include cesarean section, stillbirth, spontaneous abortion, prematurity, poor fetal growth, fetal distress, and premature rupture of membranes.
HCV-positive pregnancy was found to increase the risk of multiple maternal and perinatal outcomes, including gestational hypertension (adjusted odds ratio (AOR) 1.08 (1.03-1.144)), cesarean section (1.19 (1.15-1.22)) , premature birth (1.10 (1.05) )-1.14)), poor fetal growth 1.29 (1.21-1.37)) and fetal distress (1.11 (1.08-1.15)). However, the risk of spontaneous miscarriage was lower (0.88 (0.82-0.95)); researchers believe this is more likely to be caused by a genetic abnormality.
Chen found that these data support recent recommendations for comprehensive HCV screening during pregnancy and increased multidisciplinary collaboration in the care of women with HCV.
“Given that the CDC and ACOG are supporting universal prenatal HCV screening in 2020 and 2021, respectively, I believe increasing awareness among frontline providers (i.e., obstetric practices) is a critical first step,” Chen said. “Johns Hopkins obstetricians have fully adopted this practice and refer women who screen positive for HCV to a hepatology or infectious disease specialist for treatment.”