Increases in Hepatitis C Infection Rates Among Pregnant Opioid Users

According to the United States Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, the rate of hepatitis C virus infection (HCV) in pregnant women at the time of delivery in the United States increased from 0.8 per 1000 live births in 2000 to 4.1 per 1000 in 2015. This included increases from 87.4 to 216.9 in women with opioid use disorder and 0.7 to 2.6 in women without.

The report acknowledged that ecologic studies have previously linked increases in HCV infection with the opioid crisis. Further, opioid use disorder has increased among pregnant women, and the majority of women with HCV also have opioid use disorder. 

Hospital discharge data spanning the years 2000 to 2015 from the Healthcare Cost and Utilization Project were used to determine whether HCV infection trends among pregnant women differed on the basis of opioid use disorder status at the time of delivery. During this period, the increases noted above were observed, with the national rate of HCV infection among women giving birth increasing >400%. Among those with and without opioid use disorder, the increases were 148% and 271%, respectively. However, the rates of patients without the disorder were much lower, increasing from 0.7 to 2.6 per 1000 births compared with an increase of 87.4 to 216.9 per 1000 births among women who reported using opioids.

The analysis also found that Native American women were significantly more likely to have an HCV infection or opioid use disorder diagnosis at delivery than were non-Hispanic black women (odds ratio, 5.0; 95% CI, 2.9-8.7 and odds ratio, 5.9; 95% CI, 4.0-8.8, respectively). Epidemiologic changes in HCV infections have also prompted a review of the evidence informing current US Preventive Service Task Force and CDC guidelines for testing, which presently recommend testing for persons at high risk only.

The authors of this report noted at least 5 limitations to the study data, including the likelihood that rates of HCV and opioid use disorder were underestimated as a result of incomplete screening at birth or a lack of self-reporting because of associated stigma. Increases in the observed rates may also reflect changes in screening practices and protocols. In addition, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), used to identify discharges for in-hospital deliveries, does not differentiate between chronic or incident acute HCV infection. Further, the analyses may not represent current trends, as only data up to the third quarter of 2015 were analyzed, and the results are only generalizable to in-hospital births.

According to the report, the rates of opioid use disorder and HCV infection increased significantly between 2000 and 2015 among women delivering in hospitals in the United States. Infection rates at delivery were also significantly higher among opioid users, and the authors recommended that, “treatment of opioid use disorder should include screening and referral for related conditions such as HCV infection.”

Reference

Ko JY, Haight SC, Schillie SF, Bohm MK, Dietz PM. National trends in Hepatitis C infection by opioid use disorder status among pregnant women at delivery hospitalization – United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2019;68: 833-838.