Study Finds High Hepatitis C Infection Seroprevalence in Pregnant Women

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Results from a systematic review and meta-analysis estimating the global and regional seroprevalence of HCV antibody and determinants in pregnant women are calling attention to the high burden of exposure to HCV infection in this patient population.

The seroprevalence of HCV antibody among pregnant women was significantly greater among those with opioid use disorder (51.94%) and HIV infection (4.34%) compared to the general population of pregnant women (1.08%), further identifying age, education, sexual activity, history of blood transfusion, hospitalization, surgery, and testing hepatitis B positive as additional risk factors.¹

“Despite recommendations advocating for universal and risk-based HCV screening among adults aged 18 to 79, with a particular emphasis on pregnant women, the screening for HCV in women of childbearing ages and pregnant women remains uncommon. This is particularly uncommon in low- and middle-income countries and even in high-income countries,” wrote investigators.¹ “In addition, information on the global and regional seroprevalence of HCV antibody among pregnant women is also scarce.”

Globally, an estimated 58 million people have chronic HCV infection, with about 1.5 million new infections occurring per year. The World Health Organization’s (WHO) global hepatitis strategy aims to reduce new hepatitis infections by 90% and deaths by 65% by 2030, which will require prevalence estimates for HCV infection in different populations. The global burden of HCV infection in pregnant women represents a gap in HCV knowledge that must be addressed to support the WHO’s goal.²

To estimate the global and regional seroprevalence of HCV antibody and determinants in pregnant women, Farzaneh Abbasi, of Babol University of Medical Sciences, and colleagues searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases using search terms related to HCV infection, pregnant women, and epidemiology for peer-reviewed observational studies reporting the prevalence of anti-HCV serum antibodies between January 1, 2000, and April 1, 2023, without language or geographical restrictions.¹

Studies with overlapped datasets or participants, examined non-pregnant women of child-bearing age or women after delivery, or had no available full-text were excluded. Reviews, letters, commentaries, editorials, conference papers, randomized controlled trials with no baseline prevalence measure, case reports, and case-series studies were also excluded.¹

The initial database search yielded 3846 articles. Investigators further obtained 428 records through screening Google Scholar, the reference lists of the included studies, and relevant reviews. A total of 192 studies with 208 datasets including 148,509,760 pregnant women from 53 countries were included in the present study.¹

Investigators independently extracted and appraised data from these studies, including participant characteristics, study design, country, publication date, period of study implementation, type of serological methods, and related risk factors.¹

Pooled global seroprevalence was estimated using random-effects meta-analysis and seroprevalences was categorized according to World Health Organization regions and subregions, publishing year, countries’ income, and human development index levels. Investigators also assessed the association of potential risk factors with HCV seropositivity in pregnant women by subgroup and meta-regression analyses.¹

In the 208 datasets, 486,839 of 148,509,760 pregnant women were seropositive to HCV antibody, resulting in an overall, pooled global seroprevalence of 1.80% (95% Confidence interval [CI], 1.72–1.89). Investigators pointed out heterogeneity between studies (I2 = 99.8%; P < .001) and conducted a sensitivity analysis accordingly, excluding 4 studies from the United States accounting for 142,114,213 pregnant women. Results of this analysis indicated an estimated global seroprevalence of 3.29% (95% CI, 3.01–3.57%).¹

Pooled seroprevalences for WHO regions were the greatest in the Eastern Mediterranean region (6.21%; 95% CI, 4.39–8.29%), Africa (2.35%; 95% CI, 1.89–2.86%), and North America (2.09%; 95% CI, 1.91–2.27%). The countries with 3 or more eligible datasets with highest seroprevalence estimates were Pakistan (9.02%; 95% CI, 6.19–12.31%), Italy (7.18%; 95% CI, 1.08–17.67%), and Ghana (4.92%; 95% CI, 2.67–7.76%). Investigators noted pooled seroprevalence for the United States, the country with the greatest number of tested pregnant women, was 2.45% (95% CI, 2.25–2.66%).¹

Subgroup analyses further estimated the greatest pooled seroprevalence for lower-middle-income (3.76%; 95% CI, 2.84–4.80%) countries and those with low levels of HDI (3.74%; 95% CI, 2.82–4.78%), while high-income (1.51%; 95% CI, 1.40–1.61%) countries and those with very-high (1.39%; 95% CI, 1.30–1.49%) levels of HDI had the lowest pooled prevalence. Trend analysis indicated a non-significant decreasing trend in seroprevalence of HCV antibody with increasing income (C = −0.0000008; P = .837), but a significant decreasing trend in seroprevalence of HCV antibody with increasing HDI values (C = −0.1163; P = .028).¹

Investigators also noted the seroprevalence of HCV antibody among pregnant women was significantly greater for those with opioid use disorder (51.94%; 95% CI, 37.32–66.39) and HIV infection (4.34%; 95% CI, 2.21–7.06%) than for the general population of pregnant women (1.08%; 95% CI, 1.02–1.15%; P < .001).¹

Other important risk factors for HCV seropositivity included older age, lower educational levels, poly sexual activity, history of blood transfusion, hospitalization, surgery, abortion and sexual transmitted diseases, having scarification/tattoo or piercing, and testing hepatitis B positive.¹

“Our findings emphasized that in order to attain the WHO's ambitious goal of HCV infection elimination by 2030, it is imperative for policymakers and healthcare planners to consider a multifaceted approach, particularly with a focus on pregnant women,” investigators concluded.¹

References:

1. Abbasi F, Almukhtar M, Fazlollahpour-Naghibi A, et al. Hepatitis C infection seroprevalence in pregnant women worldwide: a systematic review and meta-analysis. The Lancet. https://doi.org/10.1016/j.eclinm.2023.102327
2. World Health Organization. Elimination of hepatitis by 2030. Hepatitis. Accessed December 7, 2023. https://www.who.int/health-topics/hepatitis/elimination-of-hepatitis-by-2030