Older Age Impacts Health, Birth Outcomes in Hospitalized Pregnant Patients with HCV

Wikrom Karnsakul, MD

Credit: Johns Hopkins

Findings from a recent study are providing novel insight into hospitalization trends among pregnant women with hepatitis C virus (HCV), highlighting an overall increase from 2010 - 2020 and further describing the impact of age on health and pregnancy outcomes.¹

Although results showed increasing hospitalization rates across all age groups, this change was most rapid among patients 26 - 34 years of age. Age served as a modifying factor for mortality, cirrhosis, preterm births, and stillbirths, with the 35+ age group experiencing the greatest health burden compared with other age groups.¹

According to the US Centers for Disease Control and Prevention, rates of new HCV infections increased by more than 60% from 2015 - 2019, with more than 63% of new HCV infections in 2019 occurring among reproductive-aged adults 20 - 39 years of age. Although chronic HCV infection does not cause symptoms in most people, maternal HCV infection has been linked to worse health and pregnancy outcomes.²

“Understanding the burden of hepatitis C in the pregnant population is important,” Wikrom Karnsakul, MD, director of the Pediatric Liver Center at Johns Hopkins, and colleagues wrote.¹ “However, as reproductive technology continues to advance and women continue to delay pregnancy to older ages, there is also a need to understand the maternal and fetal outcomes in pregnant women with hepatitis C over a range of ages.”

To describe the age-stratified clinical outcomes and trends for inpatient pregnant women with HCV in the US, investigators utilized data from the National Inpatient Sample, a database on inpatient stays and hospital discharges in the United States from the Healthcare Cost and Utilization Project. Investigators extracted and analyzed deidentified data for hospitalizations with a diagnosis of pregnancy and a concurrent diagnosis of hepatitis C based on ICD-9 and ICD-10 codes from January 1, 2010, to December 31, 2020, classifying patients into the following age groups: ≤18, 19–25, 26–34, and ≥35 years of age.¹

Out of a total of 44,636,244 pregnant women who were hospitalized between 2010 and 2020, investigators identified 195,852 with HCV and noted the median age was slightly older compared to the cohort of patients without HCV (29; interquartile range [IQR], 25–32 vs 28; IQR, 24–33; P <.001). The majority (57.9%) of patients with HCV were 26–34 years of age.¹

Between 2010 - 2020, investigators observed an increase in hospitalization rates among pregnant women with HCV, with an annual incidence rate ratio (IRR) of 1.09 (95% CI, 1.09–1.09; P <.001). Further analysis revealed the hospitalizations rates of pregnant women with HCV increased in the ≤18 age group (IRR, 1.04; 95% CI, 1.01–1.08; P = .015), the 19–25 age group (IRR, 1.06; 95% CI, 1.06–1.07; P <.001), the 26–34 age group (IRR, 1.10; 95% CI, 1.09–1.10; P <.001), and the ≥35 age group (IRR, 1.09; 95% CI, 1.08–1.10; P <.001). The 26–34 age group had the highest HCV hospitalization burden, with an age-standardized hospitalization rate of 660 per 100,000 inpatient pregnant women in 2020.¹

Overall, the maternal mortality rate was greater in the HCV pregnant cohort (0.107%) compared to the non-HCV pregnant cohort (0.018%; P <.001), especially for the 19–25 age group (0.115% vs 0.009%; P <.001), the 26–34 age group (0.051% vs 0.011%; P <.001), and the ≥35 age group (0.069% vs 0.023%; P = .020).¹

The rates of cirrhosis development were similar between the HCV and non-HCV pregnant cohorts for the ≤18 age group but were significantly greater in the HCV pregnant cohort for the 19–25 age group (0.115% vs 0.004%; P <.001), the 26–34 age group (0.317% vs 0.006%; P <.001), and the ≥35 age group (0.651% vs 0.019%; P <.001), with investigators pointing out a clear upward trend as age increased.¹

Among the HCV pregnant cohort, 151,017 (77.1%) patients delivered during hospitalization, with investigators pointing out preterm births and stillbirths were significantly greater in the HCV cohort compared to the cohort without HCV. Preterm births were greater across all age groups (P <.001) and increased with age. However, for stillbirths, the rates were significantly higher in the HCV cohort for the 26–34 age group (1.205% vs 0.706%; P <.001) and the ≥35 age group (1.341% vs 0.989%; P = .022).¹

Investigators noted increased age (odds ratio [OR], 1.01; 95% CI, 1.01–1.02; P <.001), HIV co-infection (OR, 2.22; 95% CI, 1.72–2.88; P <.001), HBV co-infection (OR, 13.41; 95% CI, 10.85–16.57; P <.001), and diabetes mellitus (OR, 1.83; 95% CI, 1.72–1.95; P <.001) were significantly associated with increased odds of developing cirrhosis.¹

Investigators outlined several potential limitations to these findings, some of which included the retrospective nature of the database, its lack of standardized diagnostic criteria, the potential for miscoding, and the inability to account for the varied genotypes and subtypes of HCV.¹

“This present study is one of the largest of its kind and provides important data on the health burden of hepatitis C in pregnant women and their fetuses/neonates over a range of ages,” investigators concluded.¹

References:

1. ^{Wasuwanich P, Rajborirug S, Egerman RS, et al. Hepatitis C Prevalence and Birth Outcomes among Pregnant Women in the United States: A 2010–2020 Population Study. Pathogens. https://doi.org/10.3390/pathogens13040321}
2. ^{US Centers for Disease Control and Prevention. Test for Hepatitis C During Every Pregnancy. Know More Hepatitis. May 27, 2021. Accessed April 29, 2024. https://www.cdc.gov/knowmorehepatitis/hcp/Test-For-HepC-During-Pregnancy.htm}