Hepatitis C Virus Antibody Screening in a Cohort of Pregnant Women: Identifying Seroprevalence and Risk Factors

Abstract

Objective: To describe the prevalence of hepatitis C virus (HCV) antibody, evaluate current risk factors associated with HCV antibody positivity, and identify novel composite risk factors for identification of groups most likely to demonstrate HCV antibody seropositivity in an obstetric population from 2012 to 2015.

Methods: The Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network initiated an observational study of mother-to-child transmission of HCV in 2012 that included offering HCV antibody screening to their entire obstetric population. Women presenting for prenatal care before 23 weeks of gestation without a known multifetal gestation were eligible. For each woman who was HCV antibody-positive, two women at similar gestational age who were HCV antibody-negative were identified and included for comparison. Risk factors were evaluated by patient interview and chart review. Women in the case group were identified to have a signal-to-cutoff value of at least 5 on the Abbott ARCHITECT platform. RNA status was evaluated for women in the case group.

Results: Of 106,842 women screened for the HCV antibody, 254 had positive results. The HCV antibody seroprevalence rate was 2.4 cases per 1,000 women (95% CI 2.1-2.7). One hundred thirty-one women in the case group and 251 women in the control group were included in the case-control analysis. Factors associated with HCV antibody positivity included injection drug use (adjusted odds ratio [aOR] 22.9, 95% CI 8.2-64.0), blood transfusion (aOR 3.7, 95% CI 1.3-10.4), having a partner with HCV (aOR 6.3, 95% CI 1.8-22.6), more than three lifetime sexual partners (aOR 5.3, 95% CI 1.4-19.8), and smoking (aOR 2.4, 95% CI 1.2-4.6). A composite of any of these potential risk factors provided the highest sensitivity for detecting HCV antibody (75/82 cases, 91%).

Conclusion: In this cohort, the seroprevalence of HCV antibody was low, and the current risk factors for HCV screening were not identified. These findings may be useful in defining new strategies for identifying mothers with the HCV antibody and the neonates susceptible to maternal transmission of HCV.

Clinical trial registration: ClinicalTrials.gov, NCT01959321.

Conflict of interest statement

Financial Disclosure

Mona Prasad disclosed that money was paid to her to from the Ohio State University for reimbursement for travel to and from meetings for work related to this study. OSU was a NICHD-funded MFMU center. She has also received funds from Gilead. Brenna L. Hughes disclosed that she received funds as a scientific advisor for the Merck CMV program (not relevant to the submitted work). Cynthia Gyamfi-Bannerman received funds from Sera and a grant from SMFM/AMAG to study prematurity. Geeta Swamy received funds from GlaxoSmithKline, Pfizer, and SAOL. Edward Chien disclosed that Gestvision and Alydia Health- Industry device trials. No salary support. Institution is compensated through capitation. Jay Iams disclosed that the Ohio Departments of Health & Medicaid made grants to Cincinnati Childrens Hospital Medical Center, which in turn contracted with The Ohio State University Wexner Medical Center for my services in the Ohio Perinatal Quality Collaborative (go to opqc.net). Ronald Gibbs received funds from Novavax/ ACI- Member Data safety management board for trial of RSV vaccine, and received a royalty for a book from Williams and Wilkins. The other authors did not report any potential conflicts of interest.

Figures

Figure 1.

Hepatitis C virus antibody seroprevalence regardless of enrollment into the observational study, Maternal–Fetal Medicine Units Network, October 2012–December 2015. Hepatitis C virus antibody positive defined as signal to cut–off value at least 5. Number of hospitals: Northeast (n=8), West (n=8), Midwest (n=7), Southwest (n=4), Southeast (n=5).

Figure 2.

Hepatitis C virus antibody seroprevalence over time regardless of enrollment into the observational study, Maternal–Fetal Medicine Units Network, October 2012–December 2015. Hepatitis C virus antibody positive defined as signal to cut–off value at least 5. Squares indicate percentage; bars indicate 95% CI. Includes 3–month interval data from October 2012 through December 2015.