Download PDF
Am J Perinatol 2021; 38(11): 1109-1116
DOI: 10.1055/s-0041-1728827
SMFM Fellowship Series Article

Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

Elisa T. Bushman
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lakshmi Subramani
3   University of Alabama Birmingham School of Medicine, Birmingham, Alabama
,
Aalok Sanjanwala
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Jodie Dionne-Odom
4   Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
,
Ricardo Franco
4   Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama
,
John Owen
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Despite the Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) recommending universal hepatitis C virus (HCV) screening in pregnancy Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) continue to endorse risk-based screening for HCV in pregnancy. We hypothesized that universal screening is associated with increased HCV diagnosis and postpartum linkage to HCV care compared with risk-based screening.

Study Design This retrospective cohort study included pregnant women screened for HCV at a single tertiary-care center. We defined two cohorts: women managed with risk-based (January 2014–October 2016) or universal HCV screening (November 2016–December 2018). Screening was performed with ELISA antibody testing and viremia confirmed with HCV ribonucleic acid (RNA) polymerase chain reaction (PCR). Primary outcomes were the rate of HCV screen positivity and postpartum linkage to care.

Results From 2014 to 2018, 16,489 women delivered at our institution, of whom 166 screened positive for HCV. A total of 7,039 pregnant women were screened for HCV: 266 with risk-based and 6,773 with universal screening; 29% (76/266) were positive HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (90/6,773) in the universal cohort. HCVAb+ women in the risk-based cohort were more likely to have a positive drug screen. Only 69% (62/90) of HCVAb+ women in the universal cohort met the criteria for risk-based testing. Of the remaining 28 women, 6 (21%) had active viremia (HCV RNA+). Of the 166 HCVAb+ women, 64% (103/166) were HCV RNA+—51 of 266 (19%) in the risk-based and 52 of 6,773 (0.8%) in the universal cohort. Of HCVAb+ women, 75% (125/166) were referred postpartum for HCV evaluation and 27% (34/125) were linked to care. Only 9% (10/103) of women with viremia initiated treatment within 1 year of delivery.

Conclusion Universal HCV screening in pregnancy identified an additional 31% of HCVAb+ women compared with risk-based screening. Given low rates of HCV follow-up and treatment regardless of screening modality, further studies are needed to address barriers to postpartum linkage to care.

Key Points

  • Ideal screening for HCV in pregnancy is unknown.

  • We explore screening strategies in pregnancy to linkage to HCV care.

  • Regardless of screening strategy there is low rates of postpartum linkage to HCV care.

Keywords

Hepatitis C - pregnancy - screening - universal - risk based

Note

This paper was previously presented at the 2020 SMFM 40th Annual Scientific Meeting.




Publication History

Received: 20 November 2020

Accepted: 02 March 2021

Article published online:
02 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults: United States, 2020. MMWR Recomm Rep 2020; 69 (02) 1-17
    CrossrefPubMedGoogle Scholar
  • 2 Owens DK, Davidson KW, Krist AH. et al; US Preventive Services Task Force. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force Recommendation Statement. JAMA 2020; 323 (10) 970-975
    CrossrefPubMedGoogle Scholar
  • 3 Hughes BL, Page CM, Kuller JA. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Hepatitis C in pregnancy: screening, treatment, and management. Am J Obstet Gynecol 2017; 217 (05) B2-B12
    CrossrefPubMedGoogle Scholar
  • 4 Centers for Disease Control and Prevention. Surveillance for Viral Hepatitis: United States, 2016. Atlanta, GA: US Department of Health and Human Services, CDC; 2017
    Google Scholar
  • 5 Rosenberg ES, Rosenthal EM, Hall EW. et al. Prevalence of hepatitis C virus infection in US states and the District of Columbia, 2013 to 2016. JAMA Netw Open 2018; 1 (08) e186371
    CrossrefPubMedGoogle Scholar
  • 6 Ly KN, Jiles RB, Teshale EH, Foster MA, Pesano RL, Holmberg SD. Hepatitis C virus infection among reproductive-aged women and children in the United States, 2006 to 2014. Ann Intern Med 2017; 166 (11) 775-782
    CrossrefPubMedGoogle Scholar
  • 7 Ghazaryan L, Smith L, Parker M. et al. Hepatitis C seroprevalence among HIV-infected childbearing women in New York State in 2006. Matern Child Health J 2016; 20 (03) 550-555
    CrossrefPubMedGoogle Scholar
  • 8 Patrick SW, Bauer AM, Warren MD, Jones TF, Wester C. Hepatitis C virus infection among women giving birth: Tennessee and United States, 2009-2014. MMWR Morb Mortal Wkly Rep 2017; 66 (18) 470-473
    CrossrefPubMedGoogle Scholar
  • 9 Dunkelberg JC, Berkley EM, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol 2014; 34 (12) 882-891
    CrossrefPubMedGoogle Scholar
  • 10 Rossi RM, Warshak CR. Prevalence of maternal hepatitis C virus infection in Ohio. Obstet Gynecol 2018; 132 (03) 708-716
    CrossrefPubMedGoogle Scholar
  • 11 Krans EE, Rothenberger SD, Morrison PK. et al. Hepatitis C virus knowledge among pregnant women with opioid use disorder. Matern Child Health J 2018; 22 (08) 1208-1216
    CrossrefPubMedGoogle Scholar
  • 12 Prasad MR, Honegger JR. Hepatitis C virus in pregnancy. Am J Perinatol 2013; 30 (02) 149-159
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis 2014; 59 (06) 765-773
    CrossrefPubMedGoogle Scholar
  • 14 Arshad M, El-Kamary SS, Jhaveri R. Hepatitis C virus infection during pregnancy and the newborn period: are they opportunities for treatment?. J Viral Hepat 2011; 18 (04) 229-236
    CrossrefPubMedGoogle Scholar
  • 15 Watts T, Stockman L, Martin J, Guilfoyle S, Vergeront JM. Increased risk for mother-to-infant transmission of hepatitis C virus among Medicaid recipients: Wisconsin, 2011-2015. MMWR Morb Mortal Wkly Rep 2017; 66 (42) 1136-1139
    CrossrefPubMedGoogle Scholar
  • 16 Page CM, Hughes BL, Rhee EHJ, Kuller JA. Hepatitis C in pregnancy: review of current knowledge and updated recommendations for management. Obstet Gynecol Surv 2017; 72 (06) 347-355
    CrossrefPubMedGoogle Scholar
  • 17 Plunkett BA, Grobman WA. Elective cesarean delivery to prevent perinatal transmission of hepatitis C virus: a cost-effectiveness analysis. Am J Obstet Gynecol 2004; 191 (03) 998-1003
    CrossrefPubMedGoogle Scholar
  • 18 Hepatitis C. AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clin Infect Dis 2018; 67 (10) 1477-1492
    CrossrefPubMedGoogle Scholar
  • 19 Prasad MR. Hepatitis C virus screening in pregnancy: is it time to change our practice?. Obstet Gynecol 2016; 128 (02) 229-230
    CrossrefPubMedGoogle Scholar
  • 20 Kwo PY, Poordad F, Asatryan A. et al. Glecaprevir and pibrentasvir yield high response rates in patients with HCV genotype 1-6 without cirrhosis. J Hepatol 2017; 67 (02) 263-271
    CrossrefPubMedGoogle Scholar
  • 21 Saab S, Kullar R, Amini C, Gounder P. WITHDRAWN: the next frontier–universal hepatitis C virus screening in pregnant women. Am J Obstet Gynecol 2020; S0002-9378 (20)30133-2
    PubMedGoogle Scholar
  • 22 Saab S, Kullar R, Gounder P. The urgent need for hepatitis C screening in pregnant women: a call to action. Obstet Gynecol 2020; 135 (04) 773-777
    CrossrefPubMedGoogle Scholar
  • 23 Boudova S, Mark K, El-Kamary SS. Risk-based hepatitis C screening in pregnancy is less reliable than universal screening: a retrospective chart review. Open Forum Infect Dis 2018; 5 (03) ofy043
    CrossrefPubMedGoogle Scholar
  • 24 Waruingi W, Mhanna MJ, Kumar D, Abughali N. Hepatitis C virus universal screening versus risk based selective screening during pregnancy. J Neonatal Perinatal Med 2015; 8 (04) 371-378
    CrossrefPubMedGoogle Scholar
  • 25 Tasillo A, Eftekhari Yazdi G, Nolen S. et al. Short-term effects and long-term cost-effectiveness of universal hepatitis C testing in prenatal care. Obstet Gynecol 2019; 133 (02) 289-300
    CrossrefPubMedGoogle Scholar
  • 26 Eijsink JFH, Al Khayat MNMT, Boersma C, ter Horst PGJ, Wilschut JC, Postma MJ. Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands. Eur J Health Econ 2021; 22 (01) 75-88
    CrossrefPubMedGoogle Scholar
  • 27 Murphy EL, Bryzman SM, Glynn SA. et al; NHLBI Retrovirus Epidemiology Donor Study (REDS). Risk factors for hepatitis C virus infection in United States blood donors. Hepatology 2000; 31 (03) 756-762
    CrossrefPubMedGoogle Scholar
  • 28 American College of Obstetricians and Gynecologists. ACOG educational bulletin. Viral hepatitis in pregnancy. Number 248, July 1998 (replaces No. 174, November 1992). Int J Gynaecol Obstet 1998; 63 (02) 195-202
    CrossrefPubMedGoogle Scholar
  • 29 Cadieux G, Campbell J, Dendukuri N. Systematic review of the accuracy of antibody tests used to screen asymptomatic adults for hepatitis C infection. CMAJ Open 2016; 4 (04) E737-E745
    CrossrefPubMedGoogle Scholar
  • 30 Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep 2013; 62 (18) 362-365
    PubMedGoogle Scholar
  • 31 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
    CrossrefPubMedGoogle Scholar
  • 32 Chaillon A, Rand EB, Reau N, Martin NK. Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States. Clin Infect Dis 2019; 69 (11) 1888-1895
    CrossrefPubMedGoogle Scholar
  • 33 CDC. Centers for Disease Control and Prevention 2020. Accessed April 15, 2021 at: https://www.cdc.gov/hepatitis/policy/isireview/PeerReviewCR.htm
  • 34 Selvapatt N, Ward T, Bailey H. et al. Is antenatal screening for hepatitis C virus cost-effective? A decade's experience at a London centre. J Hepatol 2015; 63 (04) 797-804
    CrossrefPubMedGoogle Scholar
  • 35 Wherry LR. State Medicaid expansions for parents led to increased coverage and prenatal care utilization among pregnant mothers. Health Serv Res 2018; 53 (05) 3569-3591
    CrossrefPubMedGoogle Scholar
  • 36 Kushner T, Cohen J, Tien PC, Terrault NA. Evaluating Women's preferences for hepatitis C treatment during pregnancy. Hepatol Commun 2018; 2 (11) 1306-1310
    CrossrefPubMedGoogle Scholar
  • 37 Chappell CA, Kran EE, Bunge K. et al. A Phase 1 Study of Ledipasvir/Sofosbuvir in Pregnant Women with Hepatitis C Virus. Conference on Retroviruses and Opportunistic Infections. Seattle, Washington, March 4–7, 2019
    Google Scholar
  • 38 Nolen LD, Gustin C, Seeman S. et al. Risk-based prenatal hepatitis c testing practices and results, Alaska 2013-2016. Can J Gastroenterol Hepatol 2019; 2019: 8654741
    CrossrefPubMedGoogle Scholar