U.S. Rate of Maternal HCV Infection Nearly Doubles

Maternal hepatitis C infections nearly doubled among women in reporting states -- with hepatitis B infection, smoking during pregnancy, and living in a rural county increasing the risk of infection, CDC researchers reported.

From 2009-2014, HCV infection at time of delivery among pregnant women from states that reported HCV infection on their birth certificates increased 89% -- from 1.8 per 1,000 live births to 3.4 per 1,000 (P<0.001), reported Stephen W. Patrick, MD, of Vanderbilt University, and colleagues.

In an adjusted analysis of Tennessee births, concurrent hepatitis B infection substantially increased odds of HCV infection (adjusted OR 16.60, 95% CI 12.70-21.68), along with smoking during pregnancy (adjusted OR 4.49, 95% CI 4.13-4.89), and approximately threefold higher odds among women in rural compared to urban counties, they wrote in the Morbidity and Mortality Weekly Report.

Both national and Tennessee trends were in line with recent surveillance data, they said. Studies not only found an increase in hepatitis C infection among non-pregnant U.S. adults, but that rates of HCV increased among predominantly white persons who lived in non-urban areas and had a history of injection drug use.

"Increase in maternal HCV infection coincides with the rising heroin and prescription opioid epidemics occurring the U.S. that have also disproportionately affected the rural and white population," the authors wrote.

This also aligned with data from Tennessee, which found the highest rates of maternal HCV infection in the 52 Appalachian counties in the eastern part of the state.

The authors noted that a recent analysis found that states in or near the Appalachian regions had the highest number of cases of HCV infection "suggesting that primary prevention and testing and treatment strategies for HCV infection could be targeted to these populations and areas at high risk," they wrote.

The authors examined both U.S. birth certificate data from 2009-2014 from the National Vital Statistics System and Tennessee birth certificates from the Department of Health Vital Records to examine individual characteristics and outcomes associated with HCV infection.

Overall, women with HCV at the time of live birth had an increased risk of having a high school education or less, being unmarried, having late or no prenatal care, and smoking cigarettes. Non-Hispanic black women had nearly 80% lower odds and Hispanic women nearly 70% lower odds of maternal HCV infection compared to non-Hispanic white women.

There was a substantial state-to-state variation in the rate of maternal HCV infection, ranging from 0.7 per 1,000 live births in Hawaii to 22.6 per 1,000 in West Virginia in 2014. There was a significant increase in the rate of maternal HCV infection in Tennessee -- from 3.8 per 1,000 in 2009 to 10.0 per 1,000 in 2014 (P<0.001).

The American College of Obstetricians and Gynecologists recommends selective screening of pregnant women at high risk of hepatitis C infection (including a history of injection drug use or long-term hemodialysis), and the authors said that their data "might inform expansion of the definition of women at risk, thereby improving clinical detection, particularly in areas of a state reporting increasing or high rates of incident HCV infection."

The authors argued these data were particularly concerning in light of recent research about the poor-follow up of HCV-exposed infants. The rate of vertical transmission from infected mothers to infants is estimated at 6%, they said.

Comment