Universal Screening for Hepatitis C in Pregnant Women

Universal screening is more sensitive in detecting hepatitis C virus (HCV) than risk‑based screening in the general obstetric population, according to the results of a study presented at the 2022 Conference for Antiretrovirals and Opportunistic Infections (CROI).

The American College of Obstetrics and Gynecology recently recommended universal HCV screening during pregnancy. To assess the value of this recommendation, researchers assessed case detection of HCV using risk‑based screening vs universal screening of HCV in pregnant women receiving care in Western Pennsylvania.

Universal screening was implemented in June 2020. A reminder was issued  to clinicians in the electronic medical records (EMRs) system if HCV testing was not ordered with a new obstetrics panel.

From July 2020 through June 2021, 12,588 pregnant women received universal HCV screening. Prior to June 2020, risk-based screening for HCV was done for 12,142 pregnant women throughout 2019.

After reviewing EMRs 9 months before and after prenatal care was initiated, the researchers compared HCV detection rates in each time period for universal vs risk-based HCV screening. They found that universal HCV screening increased HCV immunoglobulin G (IgG) screening from 23% to 81% (P < .001) among women entering obstetric care.

Moreover, although the rate of positive results of testing for HCV IgG was greater in those who received risk-based screening than in those who received universal screening (5.4% vs 2.3%, P < .001), the prevalence of those with positive test results for HCV IgG was lower in the general population with risk-based screening than with universal screening (1.2% vs 1.9%, P < .001).

Using reflex HCV testing increased the number of women in whom active HCV was detected from 11 to 85 (or from 0.09% to 0.68% of the obstetric population, P < .001) during the two 12-month periods. An additional 4 infants with perinatal HCV were identified with universal screening in 12 months.

“Risk-based HCV screening is insensitive for HCV detection within the general obstetric population,” said researchers. “Our findings strongly support universal HCV screening of pregnant people not only to ensure that the pregnant person is linked to treatment, but also to ensure detection of all cases of perinatal HCV transmission.”

—Ellen Kurek

Reference:

Chappell CA, Mayo SM, Grosko JA, et al. Universal hepatitis C virus screening in pregnancy: the juice is worth the squeeze.Paper presented at: Conference on Retroviruses and Opportunistic Infections, February 12–16 and 22–24, 2022; Virtual. Accessed February 21, 2022. https://ww2.aievolution.com/cro2201/index.cfm?do=abs.viewAbs&abs=2139