Alexandria, VA – Data from a new study presented this week at The Liver Meeting Digital Experience® – held by the American Association for the Study of Liver Diseases (AASLD)– found that among pregnant women with hepatitis C virus (HCV), more than 25 percent were initially diagnosed during pregnancy screenings, which supports prenatal care as an important opportunity to screen for HCV in women. However, the study also found that less than one third of infants receive appropriate HCV testing, a significant care gap.
The AASLD, U.S. Centers for Disease Control and Prevention, the United States Preventive Services Taskforce (USPST) and other leading health organizations recommend universal HCV screening during pregnancy. According to their recommendations, infants born to women who are HCV-positive should be screened postpartum. Additionally, women with cirrhosis should be evaluated for HCV and remain under a specialist’s care throughout pregnancy. To assess compliance with these recommendations, a group of researchers launched a study to evaluate pregnancy outcomes, and the rates and predictors of appropriate infant HCV screening in pregnant women with cirrhosis.
"There is limited data on HCV prevalence in pregnancy, particularly in women with advanced liver disease, and the true risk of mother-to-child transmission and associated pregnancy outcomes," says study co-author Tatyana Kushner, MD, MSCE, assistant professor of medicine, Division of Liver Diseases, at Icahn School of Medicine at Mount Sinai in New York, N.Y.
"In light of the recently updated guidelines on universal screening for HCV during pregnancy, as well as increasing data on inadequate follow-up of infants born to mothers with HCV, we wanted to further investigate these questions, particularly in women with advanced liver disease. It is critical to have more information on HCV testing and infants in order to further inform guidelines, particularly from obstetrics societies, which still recommend only risk-based, not universal, HCV screening, as well as to draw attention to the need for funding and programs to improve appropriate testing and care of women with HCV and their infants," she says.
This population-based, retrospective cohort study used routinely collected health care and mother-infant linkage data from pregnant, HCV-positive women ─ those who tested positive for HCV RNA either before or during pregnancy- who were also verified to have cirrhosis. The researchers defined appropriate HCV infant testing as an infant HCV antibody test given at 12 months of age or older.
Out of 1,393 pregnancies of HCV-positive mothers, the study’s data included 194 births from 151 women with cirrhosis from 2000-2014. The average age of the mothers at the time of pregnancy was 32, and 89 percent of the mothers were living in urban settings. Thirty-one percent of the women in the study had a substance use disorder, including alcohol and opioid use.
According to their findings, 51 out 151 women were initially diagnosed with HCV during pregnancy, 106 were diagnosed with cirrhosis before pregnancy and 88 were diagnosed with cirrhosis during or after their pregnancy. Less than three percent had liver complications during pregnancy. Adverse pregnancy outcomes experienced by the women in the study included intrahepatic cholestasis ─ a liver disorder that occurs during pregnancy, hypertensive complications, gestational diabetes and postpartum hemorrhage.
Out of 194 infants, only 32 percent received appropriate HCV testing. Analysis of the data showed that appropriate infant testing was associated with the timing of cirrhosis diagnosis and maternal age, while maternal liver complications and adverse pregnancy outcomes were not associated with appropriate infant testing.
"Our study’s findings demonstrate a high prevalence of adverse outcomes, such as cholestasis of pregnancy in women with HCV, as well as low rates of appropriate follow-up and testing of infants born to mothers with HCV and advanced liver disease. This draws attention to the importance of identifying women with HCV during pregnancy with appropriate screening, as well as close monitoring during pregnancy, and the importance of identifying ways to improve follow-up of their infants," says Dr. Kushner. "In the setting of the recently updated national guidelines for universal HCV screening in pregnancy, our study draws attention to the work we need to do in order to optimize outcomes in women with HCV and their children."
Dr. Kushner will present these findings at The Liver Meeting Digital Experience™ during Parallel: Hepatitis C: Epidemiology on November 14 at 5:30 PM ET. The corresponding abstract "Low Adherence to Infant HCV Testing Guidelines Among Pregnant Women with HCV Cirrhosis" can be found in the journal, HEPATOLOGY.
About the AASLD
AASLD is the leading organization of clinicians and researchers committed to preventing and curing liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.