Maternal HCV Infection Rates on the Rise in the United States


A new study published in the CDC's Morbidity and Mortality Weekly Report details an increasing trend of hepatitis C infection in pregnant women, especially in the state of Tennessee.

The hepatitis C virus (HCV) chronically infects an estimated 2.7 to 3.9 million people in the United States. The virus is spread when a person comes into contact with HCV-infected blood, either through sharing needles for intravenous drug use or by being born to an HCV-positive mother. An article published in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) by lead investigator Stephen W. Patrick, MD, from the Vanderbilt University School of Medicine, examined the rates of maternal HCV infections in the United States, specifically in the state of Tennessee.

The study was prompted by recent data that demonstrated increased HCV infection rates among white adults who reside in non-urban areas and have a history of intravenous drug use. As of 2003, HCV infection became an item on birth certificates in the United States. The authors analyzed infant birth certificates to estimate the HCV infection rate among pregnant women in the United States. In addition to the birth certificates, the authors analyzed vital records from Tennessee, which include demographic data as well as data detailing concurrent infections.

Dr. Patrick and his colleagues found that between 2009 and 2014, there was an 89% increase in the prevalence of HCV among pregnant women. The highest rate was found in West Virginia, with approximately 22 babies born to HCV-infected mothers per 1000 live births. In Tennessee, there was a 163% increase in maternal HCV infection from 2009 to 2014.

When looking specifically at the demographics of infection in Tennessee, the authors noted that there was large variation between the 95 counties in Tennessee, with the highest rates of maternal HCV infection occurring in the Appalachian counties located in the eastern part of the state. Compared to women without HCV infection, women diagnosed with HCV during pregnancy were found to have an increased chance of being unmarried, having minimal prenatal care, smoking cigarettes, and having a high school education or less.

In addition, pregnant black women were found to have an 80% reduced chance to being diagnosed with HCV than pregnant white women. For pregnant Hispanic women, the odds were reduced by 70%. In terms of demographics, the authors found that HCV infection in pregnant women was three times higher in those from rural counties as opposed to large, metropolitan cities. Furthermore, having a concurrent HBV infection increased the odds 17-fold of being diagnosed with HCV.

To explain the observed increased rates of maternal HCV infection, the authors note that this trend coincides with increased heroin and prescription opioid use, particularly among pregnant women.

Although Dr. Patrick and his colleagues’ work details an increasing trend in HCV infection rates among pregnant women, there are some limitations to the study, including relying on accurate coding of birth certificates. However, the implications of this work are to shed light on the need for increased screening for HCV infection among women that may become pregnant as well as advocate for treatment options that could reduce transmission from an HCV-infected mother to her baby.

Samar Mahmoud graduated from Drew University in 2011 with a BA in Biochemistry and Molecular Biology. After two years of working in industry as a Quality Control Technician for a blood bank, she went back to school and graduated from Montclair State University in 2016 with an MS in Pharmaceutical Biochemistry. She is currently pursuing her PhD in Molecular and Cellular Biology at the University of Massachusetts at Amherst.

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