Hepatitis C often goes undetected in at-risk infants, according to new study

Naveed Saleh, MD, MS, for MDLinx | June 15, 2018

Only 30% of infants exposed to hepatitis C virus (HCV) perinatally are screened for the disease, according to a new study published in Pediatrics.

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Pregnant women infected with HCV may not be adequately counseled by their physicians as to the risk of perinatal HCV transmission and the importance of postnatal HCV screening.

“The emerging data from our study reveal that the epidemic of HCV in pregnant women is growing and that most perinatally infected children are not being identified, impeding linkage to care,” wrote lead author Catherine A. Chappell, MD, MSc, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA.

As a result of the opioid epidemic, more people of reproductive age have been using intravenous drugs, thus leading to a rise in HCV infection. One recent study pegged the increase at 89% among pregnant women between 2009 and 2014 in the United States. HCV is transmitted from mother to child in about 5.8% of cases, meaning that each year an estimated 2,700 to 4,000 children are perinatally infected with HCV. Approximately 80% of children with perinatal HCV infection go on to develop chronic infection.

Because of the passive placental transfer of maternal HCV IgG antibodies between mother and infant, HCV antibody testing before 18 months of age results in a substantial number of false positives. Instead, experts recommend that an HCV antibody test be performed when the child is older than 18 months.

Despite clear recommendations regarding HCV screening in infants, many infants exposed to HCV are never screened; often, these children go undetected for HCV. Experts have yet to elucidate whether this gap results from lapses in well-child care follow-up or inadequate screening in well-child care programs.

“Our objectives in this study were to determine the prevalence of HCV infection at a large, tertiary care maternity hospital from 2006 to 2014 and the rate and type of pediatric HCV testing for HCV exposed children who were engaged in well-child services,” the researchers wrote. “We also compared obstetric and neonatal outcomes among pregnant women with and without HCV.”

In this population-based, retrospective cohort, researchers identified 1,043 pregnant women with HCV who delivered at Magee-Women’s Hospital of the University of Pittsburgh Medical Center between 2006 and 2014. They then compared demographic obstetric data between pregnant women who were either infected or not infected with HCV.

Finally, they examined the records of infants born to mothers with HCV who went on to receive well-child care in their health system. The health system includes 30 hospitals in the greater western Pennsylvania area; this minimizes the likelihood of missing data due to patient migration.

The team found that between 2006 and 2014, HCV prevalence increased by 60%. Furthermore, pregnant women with HCV were more likely to be white,

Infants born to women with HCV were more likely to be preterm and have low birth weight. Moreover, the researchers found that only 323 of 1,043 patients (31%) went on to receive well-child visits through their institution, with only 96 of these infants (30%) eventually screened for HCV.

Dr. Chappell and co-authors offer a few explanations for why many infants who are exposed to HCV don’t receive screening.

First, information concerning maternal HCV diagnosis may not make it into the electronic records either because pediatricians don’t ask about HCV risk exposures or mothers don’t want to bring up previous drug use.

Second, many pregnant women don’t realize that they are infected with HCV due to lack of universal screening.

Third, pregnant women infected with HCV may not be adequately counseled by their physicians as to the risk of perinatal HCV transmission and the importance of postnatal HCV screening.

The researchers concluded the study by making a case for the universal HCV testing during pregnancy. They also recommend that future researchers “focus on interventions to increase screening in infants who are at risk for perinatal HCV acquisition by including technology to improve the transfer of maternal HCV status to the pediatric record and increase pediatric provider awareness regarding HCV screening guidelines.”

To read more about this study, click here

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