Prenatal testing and postpartum treatment for hepatitis C virus among women with opioid use disorder
Lucas Gosdin, Kathryn Miele, Shin Y. Kim, Marcela C. Smid, Julie H. Shakib, Judette M. Louis, Tanner Wright, Neil S. Seligman, Carrie Irvine, Pilar M. Sanjuan, Lawrence Leeman, Michelle L. Henninger, Autumn Davidson, Elisha M. Wachman, Kara M. Rood, Anna Bartholomew, Suzanne Gilboa, Kate R. Woodworth, Van T. Tong, Lakshmi PanagiotakopoulosAbstract
Introduction
In the past decade, hepatitis C virus (HCV) infections among pregnant women increased dramatically in the United States, rising in parallel with the opioid crisis and increasing the number of children at risk for HCV. People with HCV infection that remains untreated are also at increased risk of cirrhosis, liver cancer, and death.
Objective
To describe timing of HCV testing during pregnancy and postpartum HCV treatment among women with opioid use disorder (OUD).
Methods
This analysis draws from the MATernaL and Infant clinical NetworK (MAT‐LINK) surveillance system's cohort of women with OUD during pregnancy, which is collected from electronic health records of seven healthcare systems. Women were included if they had OUD during pregnancy and a known pregnancy outcome during January 1, 2014–August 31, 2021. Antenatal HCV testing was examined by characteristics of pregnant women (including age, race, ethnicity, insurance, urbanicity, parity, and medication for OUD) using multinomial regression. Hepatitis C diagnosis (positive antibody or nucleic acid test or diagnostic code) and postpartum treatment were also examined.
Results
Among the 5533 pregnancies in this cohort, 1506 (27.2%) had no testing or diagnostic code for hepatitis C including 1296 who received prenatal care. Among 910 pregnancies with no prenatal care, 700 (76.9%) had HCV testing or diagnostic codes. Among pregnancies with HCV testing or diagnostic codes, 55.8% had a hepatitis C diagnosis. Women were more likely to have HCV testing if they were White or Hispanic, had government‐funded insurance, or received medication for OUD during the pregnancy. From five clinical sites with prescription information available, 9.7% ( n = 81/836) of those with a detectable viral load had a direct‐acting antiviral prescription in the first year postpartum.
Conclusion
Women with OUD during pregnancy have a high burden of hepatitis C. Despite national recommendations, gaps remain in HCV testing during pregnancy and HCV treatment postpartum. HCV testing among women with no prenatal care indicates that testing is occurring outside of traditional prenatal care settings. Receiving medication for OUD was associated with being tested for HCV during pregnancy. Improved HCV testing, treatment, and management for pregnant women with OUD represent opportunities for improving overall health and eliminating HCV infection.