Hepatitis C Virus in Pregnancy: A Systematic Review of the Literature

Abstract

Objective The aim of this study was to systematically review the literature to summarize recent demographic characteristics of hepatitis C virus (HCV) infection during pregnancy and the efficacy of risk-based versus universal screening. Study Design PubMed, EMBASE, and Cochrane Library were searched to identify relevant studies. Studies that recognized hepatitis C as a primary or secondary outcome, with pregnant women as the population and written in English, were included. Studies were excluded if they were abstracts only, written in foreign language, or published prior to 1992. Two researchers independently screened all the studies by titles, abstracts, and full text. Conflicts were settled by a third researcher. Results A total of 698 studies were identified with 78 fitting inclusion criteria. In total, 69 epidemiologic and 9 comparison studies were found. Identified risk factors for HCV infection include intravenous or illicit drug use, sexually transmitted coinfection, high-risk behaviors in the partners, high parity, and history of miscarriages or abortions. Demographic characteristics associated with HCV include non-Hispanic white race, American Indian or Alaskan Native ethnicity, and increasing age. Providers may fail to adequately screen for each risk factor, and up to two-thirds of women with a known risk factor are not screened under current guidelines. Finally, up to 27% of HCV+ women have no identifiable risk factors for infection. Conclusion There is evidence that risk-based screening fails to identify a large proportion of HCV positive women in pregnancy and that pregnant women with HCV risk factors and consistent with current screening guidelines fail to be tested. We urge for the adoption of universal screening to identify these women and offer treatment.

Estimating the number of livebirths to Hepatitis C seropositive women in England in 2013 and 2018 using Bayesian modelling

“…Risk-based screening of pregnant women in other countries follows differing protocols with respect to risk groups (e.g. some include women with an IDU history while others also extend to those with a sexual partner who inject drugs; other protocols include women from high-prevalence areas) [ 20 ]. A few studies have compared risk-based with universal screening, and have shown that women with a known risk factor, such as injecting drug use, may not be screened under current guidelines [ 20 ].…”

“…some include women with an IDU history while others also extend to those with a sexual partner who inject drugs; other protocols include women from high-prevalence areas) [ 20 ]. A few studies have compared risk-based with universal screening, and have shown that women with a known risk factor, such as injecting drug use, may not be screened under current guidelines [ 20 ]. In England, although coverage of HCV testing among high-risk pregnant women is unknown, testing of migrant groups in primary care settings is variable.…”

“…A recent global policy review found that only 26% of national strategic plans and/or clinical practice guidelines included recommendations on HCV screening in pregnancy [ 18 ]. However, universal screening of pregnant women for HCV infection could facilitate earlier diagnosis of infection in children, as well as identify women for treatment with DAAs, contributing to goals of HCV elimination in England and globally [ 3 , 19 , 20 ].…”