Rates of HCV Screening Low Among Children Exposed in Pregnancy

By Megan Brooks

May 03, 2018

NEW YORK (Reuters Health) - Hepatitis C virus (HCV) infection is on the rise among pregnant women due to the opioid epidemic, yet most perinatally infected children are flying under the radar due to insufficient screening, warn researchers from Pennsylvania in a new paper.

Current guidelines recommend that all infants that are perinatally exposed to HCV be screened for perinatal transmission, researchers note in Pediatrics, online May 2.

"However, considering most infants that are exposed to HCV are not screened, strategies to improve screening rates should be implemented," lead author Dr. Catherine Chappell from Magee-Womens Research Institute and the University of Pittsburgh told Reuters Health by email. "Also, given the increase in HCV prevalence among pregnant women and given the difficulties identifying women with current or remote histories of drug use, universal HCV screening for all pregnant women should be implemented."

Among nearly 88,000 pregnant women who delivered at Magee-Womens Hospital of UPMC between 2006 and 2014, 1.2% had HCV infection, Dr. Chappell and colleagues found. Compared with HCV-uninfected women, HCV-infected women were more likely to be younger than 30, white, have Medicaid insurance and an opiate-use disorder.

Over the nine-year study period, the rate of HCV infection among women giving birth at the hospital rose 60%, from 1,026 to 1,637 per 100,000 women.

Among 1,025 infants (98%) born to HCV-infected women with available data, 323 (32%) received well-child services but only 96 of these infants were tested for HCV and only about three-quarters of these infants received an optimal initial HCV screening test. Seven infants (8.4%) had evidence of perinatal HCV transmission.

"Programs that are focused on identifying pregnant women with HCV infected infants are critical to the prevention of the long-term sequelae of HCV infection, particularly now that there are increasingly easy and better-tolerated HCV treatments available for children," the authors write in their article.

"Without appropriate screening, children who are at risk for perinatal transmission may remain undiagnosed until they become symptomatic or have abnormal liver enzyme levels found incidentally."

"Delays in diagnosis could lead to delays in appropriate referrals and curative treatment or irreversible liver disease, such as cirrhosis or hepatocellular carcinoma," they add.

A recent study found an 89% increase in HCV infection among pregnant women in the U.S. between 2009 and 2014.

Dr. Chappell and colleagues say research is needed on interventions to increase screening in infants who are at risk for perinatal HCV infection, such as using technology to improve the transfer of maternal HCV status to the pediatric record and increasing pediatricians' awareness regarding HCV screening guidelines.

The study had no commercial funding. Dr. Chappell and two co-authors receive funding from Gilead Sciences related to HCV treatment of pregnant and postpartum women.

SOURCE: https://bit.ly/2HIl8tx

Pediatrics 2018.