Pregnant Women in Rural Regions Face Greater HCV, Preterm Birth Burden

Byron Calhoun, MD

Credit: Charlotte Lozier Institute

Hepatitis C virus (HCV) presents a significant public health issue, although findings from a recent study are calling attention to its disproportionate impact on pregnant women in rural populations.¹

Conducted at a single tertiary care clinic in Appalachia, results from the retrospective cohort study called attention to an 11.94% HCV infection rate and a 17.8% preterm birth rate, both significantly greater than the national average and indicative of the need for increased treatment opportunities in this population with continuity of care challenges.¹

Hepatitis C virus (HCV) presents a significant public health issue, affecting an estimated 58 million people worldwide. This burden is especially pronounced in reproductive-aged adults, supporting the US Center for Disease Control and Prevention’s HCV screening recommendation for all pregnant people. Identifying HCV in this patient population allows them to access treatment and identifies at-risk infants in need of testing and ongoing monitoring, yet many patients still go untested and thus untreated.^2,3

“HCV as a precursor to preterm labor has received recent attention,” wrote Byron Calhoun, MD, professor and vice-chair in the department of obstetrics and gynecology at West Virginia University-Charleston, and colleagues.¹ “Most studies focus on inner-city populations and have not explored the opioid epidemic's impact in rural regions.”

To address this gap in research, investigators assessed the prevalence of HCV in a cohort of pregnant women receiving prenatal care at a single tertiary care clinic in Appalachia and conducted further analyses to determine its association with preterm birth, defined as gestation <37 weeks. Data on HCV status, viral load, preterm birth, and maternal characteristics and morbidity were retrospectively collected from pregnant patients universally screened for HCV between 2017 and 2021, excluding those with multiple gestations and uterine anomalies.¹

Among the total study cohort, the HCV infection rate was 11.94% (119.4 per 1000), which investigators pointed out is 5 times the rate of 22.6 per 1000 live births in West Virginia in 2014 and 35 times the national rate of 3.4 per 1000 live births. Viral loads were detected in 6.38% of patients.¹

Investigators pointed out patients in the HCV-positive group (n = 92) were older than those in the HCV-negative group (n = 628) (38.9 years of age vs 26.9 years of age; P <.001) and had lower rates of obesity (8.7% vs 31.2%, respectively; P <.001).¹

A total of 720 patients had birth outcome data available, of which 326 (45.3%) had high rates of tobacco use and 189 (26.3%) had substance abuse. The preterm birth rate was 17.8%, nearly double the national average (10.09%).¹

Although the HCV-positive group had significantly greater rates of tobacco use (78.3% vs 40.4%; P <.001) and substance use (63.0% vs 24.0%; P <.001), investigators noted there was no significant difference in preterm birth compared to the HCV-negative group (16.3% vs 18.0%; P = .534).¹

“While there have been studies showing an association between HCV and [preterm birth], our study showed no statistically significant difference in [preterm birth] rates between HCV-positive and HCV-negative patients. This may be attributable to high incidence of [preterm birth] contributory factors in the study population,” investigators concluded.¹

References:

1. Pollock TS, Robert CA, Seybold DJ, et al. Prevalence of hepatitis C among pregnant women in an Appalachian population. Journal of Viral Hepatitis. https://doi.org/10.1111/jvh.13911
2. World Health Organization. Hepatitis C. Newsroom. July 18, 2023. Accessed January 25, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
3. Centers for Disease Control and Prevention. Test for Hepatitis C During Every Pregnancy. Know More Hepatitis. May 27, 2021. Accessed January 25, 2024. https://www.cdc.gov/knowmorehepatitis/hcp/Test-For-HepC-During-Pregnancy.htm