BACKGROUND: Recent vital statistics show an increasing trend in hepatitis C (HCV) infection among pregnant women in Clark County, Nevada. A better understanding of the HCV burden among high-risk women would help inform and evaluate local testing and care programs, as well as support more efficient strategies to address the syndemics of HCV, HBV and STIs in Clark County. To facilitate this, this study examined the prevalence and characteristics of HCV infection in pregnancy in Clark County, and identified key risk factors that can be targeted by mitigation and prevention activities.
METHODS: Clark County birth certificate data from 2010 to 2015 were utilized to assess prevalence of HCV diagnosis in pregnancy over time. Logistic regression models were implemented to estimate HCV risk and its relationship to maternal and demographic as well as socio-behavioral variables including age, race, education, marital status, prenatal care utilization, payment source, tobacco and prescription drug use, and maternal co-morbidities such as cardiac disease, diabetes, hypertension, lung disease, hepatitis B infection, and other sexually transmitted infections (STI).
RESULTS: The prevalence of HCV among mothers increased from 0.9 to 1.6 per 1,000 live births in Clark County from 2010-2015 (p for trend<0.01). HCV-positive mothers were more likely to be non-Hispanic white, have no college education, be unmarried, smoke during pregnancy, have delayed or no prenatal care, and experience adverse birth outcomes such as preterm or low birth weight births. In multivariable-adjusted analyses (n=141,583), the independent correlates of HCV were older maternal age, no college education, unmarried, delayed or no prenatal care, smoking, prescription drug use, co-occurring hepatitis B or STIs, and Medicaid payer source.
CONCLUSIONS: Maternal infection with HCV identified from vital records can be integrated with current morbidity surveillance to help develop locally relevant viral hepatitis epidemiologic profiles. Factors defining at-risk populations such as comorbidities, Medicaid insurance, and gaps in prenatal care often complicate HCV testing, linkage to care, and harm reduction efforts. These findings underscore the need for enhanced outreach programs (e.g., HCV testing in high-risk populations) and coordination of local resources and partnerships to expand access to preventive and treatment programs for vulnerable women in Clark County.