Hepatitis C Virus (HCV) impacts 3.2 million individuals nationwide. Recently, surveillance data suggest increased rates of HCV among young adults; however, there are no data describing the impact of this recent rise of HCV on pregnant women. Understanding HCV prevalence and risk among pregnant women would inform screening and management practices among high-risk women and exposed infants. The purpose of this study was to determine: 1) trends in HCV infection in pregnancy, 2) birth outcomes associated with HCV infection, and 3) risk factors associated with HCV infection in pregnancy.
METHODS:
We utilized birth certificate data from Tennessee and the United States for comparative trend analysis for live births from 2009 to 2014. Multiple imputation was utilized to account for missing data. Risk of HCV diagnosis in pregnancy was modeled, based upon the literature including: age, education, marital status, race, urbanicity location, late prenatal care, smoking status and concurrent sexually transmitted infections (STIs).
RESULTS:
Among 482,681 births in Tennessee during our study period, 3,116 pregnant women had HCV. From 2009 to 2014, the rate (per 1,000 live births) of HCV in pregnant women grew from 3.8 to 10.0 in Tennessee, compared to 1.8 to 3.4 nationwide. Compared to all other Tennessee pregnant women, those with HCV were more likely (p<0.001) to have less than a high school education (72.9% vs. 46.3%), be unmarried (67.3% vs. 44.0%), be non-Hispanic White (91.6% vs. 67.2%), have late or no prenatal care (47.1% vs. 29.8%), smoke during pregnancy (65.8% vs. 16.4%), have concurrent Hepatitis B (2.8% vs. 0.2%), and live in rural noncore counties (13.0% vs. 8.8%). Infants of mothers with HCV were more likely to be low birthweight (17.1% vs. 9.0%), preterm (16.3% vs. 11.1%) and admitted to a NICU (11.0% vs. 6.7%). In adjusted analyses, residence in a rural noncore compared to large urban counties (OR 3.07; 95%CI 2.55-3.69), smoking (OR 4.49; 95%CI 4.13-4.89) and concurrent Hepatitis B infection (OR 16.60; 95%CI 12.70-21.68) were associated with the highest risk of HCV infection.
CONCLUSIONS:
HCV infections among pregnant women are an emerging and potentially modifiable threat to maternal and child health. Infants of mothers with HCV are at increased risk for adverse birth outcomes. As HCV prevalence increases among reproductive-aged women, clinicians and public health officials should consider individual and population-level opportunities for prevention and risk mitigation.