Increases in Maternal Hepatitis C Mirrors the Rise in Injection Drug Use

Figure 1: Rate of hepatitis C infection among pregnant women per 1,000 live births, by state — United States, 2014

Perinatal, or mother-to-child, transmission is the leading cause of childhood hepatitis C (HCV) infection. According to the Centers for Disease Control and Prevention (CDC), maternal HCV infections nearly doubled from 2009 to 2014, and the number of infants born to women who are infected with HCV also increased.

According to a May 2017 MMWR from CDC, increases in maternal HCV cases appear to be higher in some states, and among women who are white and live in nonurban areas. West Virginia had the highest maternal HCV infection rate in 2014 (22.6 per 1,000 live births). An MMWR from January 2017 indicated similar trends, including a 124% increase in infants born to HCV-infected mothers in Kentucky compared to a 68% increase nationally.

The increase in maternal HCV infections appears to be tied to increases in injection drug use, a major risk factor for HCV infection, and an overall increase in new HCV infections among young people. In a December 21, 2017 press release, CDC linked the significant rise in HCV infections to the opioid epidemic and called for an integrated response that includes supporting drug treatment and recovery programs as well as increasing testing efforts.

In December 2017, the National Viral Hepatitis Roundtable held a webinar: Hepatitis C Among Pregnant Women to discuss the implications of the increase in perinatal transmission of HCV. The webinar included presentations from leading researchers and practitioners across the U.S., including Dr. Kimberly Page, University of New Mexico Health Sciences Center; Dr. Stephen Patrick, Vanderbilt University School of Medicine; Kathy Sanders, Kentucky Department of Health; and Dr. Sarah Schillie, Division of Viral Hepatitis, CDC.

The presenters shared potential policies and strategies to increase the identification and follow-up of women who are infected with HCV and their infants. A key issue proposed for further discussion was universal, rather than risk-based, screening during pregnancy, since many women may not disclose past or current injection drug use due to fear of losing custody of their child.

The presenters pointed out that while there are no current recommendations to prevent perinatal transmission of HCV, measures can be taken to prevent mother-to-infant transmission. Their recommendations mirror the CDC’s call for more intensive HCV testing and treatment efforts, including:

• Screening and treatment for HCV before pregnancy to prevent mother to child transmission, as well as disease progression in women with HCV infection.
• Identification of pregnant women who are infected with HCV, which is beneficial to both the woman and her infant (CDC) in terms of follow up for the infant after birth, and for post-pregnancy treatment of the mother.

Eliminating mother-to-child transmission of hepatitis B and C is an important strategy in addressing viral hepatitis and meeting the goals of the National Viral Hepatitis Action Plan, 2017 – 2020 (Action Plan). The Action Plan is a strategic framework that highlights the commitment of more than 20 federal partners working together to fight viral hepatitis in partnership with states, counties, cities and hundreds of organizations around the country. To learn more, download the plan and see how to get involved.