Pregnant Women with Opioid Use Disorder and Hepatitis C Infrequently Receive Hepatitis C Services

Pregnant women with opioid use disorder (OUD) have a high prevalence of hepatitis C (HCV) infection and, if infected, may transmit the virus to their children at delivery. Researchers retrospectively assessed data on 791 pregnant women (97% white, 13% married, 17% employed) receiving opioid agonist therapy (OAT) who received prenatal services at a single large academic medical center. They assessed whether the women were screened for HCV (either an HCV antibody test or documentation of a prior positive test), for predictors of screening, and, if infected, whether the women received HCV viral load testing, hepatitis A vaccine, hepatology referral (and attendance), and postpartum HCV treatment.

• 611 (72%) pregnant women receiving OAT were screened for HCV and, of those screened, 369 (60%) were infected.
• In adjusted analyses, HCV screening was more likely to occur in women with benzodiazepine use (odds ratio [OR], 1.7), injection drug use (OR 6.2), legal problems (OR 2.2), children not in mother’s custody (OR 1.8), and partner with substance use (OR 2.4). Screening was less likely in married women (OR 0.5), private prenatal practice (OR 0.3), and among women receiving buprenorphine (OR 0.5).
• Among women with HCV, the rates of receiving specific HCV services were: HCV viral load testing (26%), hepatitis A vaccination (10%), referral to hepatology during pregnancy (77%), attendance at hepatology (25%), and postpartum HCV treatment (2%).

Comments:

Although it was conducted at a single site, this study illustrates some important gaps in the care of pregnant women with OUD. Certainly, a case can be made that given its high prevalence, pregnant women with OUD should have HCV screening done to identify their treatment needs and whether or not to treat the neonate. The low rates of services among the HCV-infected pregnant women with OUD indicate a need for improved quality and coordination of HCV care during and after pregnancy. The availability of effective interferon-free antiviral therapy makes the improvement of prenatal and postpartum HCV services even more pressing.

Kevin L. Kraemer, MD, MSc

Reference:

Krans EE, Zickmund SL, Rustgi VK, et al. Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: a retrospective cohort study. Subst Abuse. 2016;37:88–95.