HCV Rates Double in Pregnancy, Up Risk for Vertical Transmission

Troy Brown, RN

October 27, 2017

Researchers in one US state have reported almost a doubling in the proportion of pregnant Medicaid recipients who had hepatitis C virus (HCV) infection, with obvious implications for vertical transmission of the virus from mother to child.

They explain that the exponential increase in hepatitis C among women of childbearing age is attributed to the opioid crisis in the United States.

"Fueled by the increase in injection drug use ensuing from the opioid epidemic, the proportion of infants born to HCV-infected women is increasing nationwide," say Theresa Watts, MPH, and colleagues in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, published online October 27.

"Vertical transmission is the most common mechanism of HCV infection for children, reported to occur in approximately 6% of infants born to women with HCV infection, and approximately twice as often in women who are coinfected with HCV and human immunodeficiency virus (HIV)," they explain.

But they also found that only a third of newborns in the state, Wisconsin, were tested for HCV infection.

"Improvements in HCV screening practices among pregnant women and infants could enhance identification of infants at risk for vertical transmission of HCV," they stress.

Substantial Gap in Monitoring Infants at Risk for HCV Vertical Transmission

The aim of the current study was to estimate the proportion of women enrolled in Wisconsin Medicaid with HCV infection during pregnancy and estimate the frequency of HCV testing and infection in infants born to HCV-infected women.

Maternal name and date of birth from HCV reports in the Wisconsin Electronic Disease Surveillance System were linked to Wisconsin Medicaid data for 2011–2015 births.

During this period, in the Wisconsin Medicaid population, the proportion of women who had evidence of HCV infection during pregnancy increased 93%, from 1 in 368 pregnancies to 1 in 192.

But only 34% of the infants born to women with evidence of HCV viremia during pregnancy were tested for HCV according to recommendations, "revealing a substantial gap in monitoring infants at risk for HCV vertical transmission," the researchers say.

Mother-to-infant vertical transmission was documented in 4% of infants (7 of 183 born to women with evidence of HCV viremia during pregnancy).

"Clinical signs of pediatric HCV infection often manifest slowly and can range in severity from being asymptomatic to fatal; liver transplantation is sometimes required," the authors note.

The current recommendation for identification of HCV during pregnancy is for risk-based screening.

Pregnancy and postpregnancy care are ideal times to test women and link those with infection to HCV care or treatment because these are times when women typically use healthcare services, the authors explain.

However, "unlike other bloodborne infectious diseases that have a risk for vertical transmission, such as hepatitis B virus or HIV, for HCV there is no perinatal intervention available that has been shown to reduce vertical HCV transmission," they note.

But presence of maternal HCV viremia (HCV RNA positivity) is a risk factor thought to increase the likelihood of vertical HCV transmission.

"To improve surveillance of HCV vertical transmission, support identification of cases, and evaluate health outcomes of infected infants," it would be pertinent for state and local health departments to follow guidelines issued in a recent position statement for reporting and national notification of perinatal HCV infection, issued by the Council of State and Territorial Epidemiologists

"Adoption of this position statement…along with enhanced identification of HCV among women of childbearing age, can improve care for HCV-infected women and infants at risk for HCV vertical transmission," the study authors conclude.

The authors have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published online October 27, 2017. Full text

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