Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Netw Open. 2023 Jul 3;6(7):e2324770. doi: 10.1001/jamanetworkopen.2023.24770.
Injection drug use is the primary risk factor for hepatitis C virus (HCV) infection in adults. More than one-third of newly reported HCV cases occur in women, particularly among persons aged 20 to 39 years. However, nationally representative data on HCV during pregnancy are limited.
To estimate the temporal trend of HCV-positive pregnancies during the opioid epidemic and identify HCV-associated maternal and perinatal outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study was performed with data from the US, from calendar year 1998 through 2018. Data analysis was conducted from November 14, 2021, to May 14, 2023. Participants included women during in-hospital childbirth or spontaneous abortion in the National Inpatient Sample of the Healthcare Cost and Utilization Project.
Maternal HCV infection.
The main outcome was the temporal trend, measured as change in the annual prevalence, in the prevalence of HCV positivity among pregnant women since the start of the opioid epidemic in the late 1990s. Secondary outcomes were the associations shown as relative odds between maternal HCV infection and maternal and perinatal adverse events.
During the study period, more than 70 million hospital admissions resulted in childbirth or spontaneous abortion. Among them, 137 259 (0.20%; 95% CI, 0.19%-0.21%) involved mothers with HCV; these individuals were more often White (77.4%; 95% CI, 76.1%-78.6%), low-income (40.0%; 95% CI, 38.6%-41.5%), and likely to have histories of tobacco (41.7%; 95% CI, 40.6%-42.9%), alcohol (1.8%; 95% CI, 1.6%-2.0%), and opioid (28.9%; 95% CI, 27.3%-30.6%) use compared with HCV-negative mothers. The median age of women with HCV was 28.0 (IQR, 24.3-32.2) years, and the median age of HCV-negative women was 27.2 (IQR, 22.7-31.8) years. The prevalence of HCV-positive pregnancies increased 16-fold during the study period, reaching 5.3 (95% CI, 4.9-5.7) cases per 1000 pregnancies in 2018. Age-specific prevalence increases ranged from 3-fold (age, 41-50 years) to 31-fold (age, 21-30 years). Higher odds of cesarean delivery, preterm labor, poor fetal growth, or fetal distress were associated with HCV-positivity during pregnancy. However, no significant differences were observed in gestational diabetes, preeclampsia, eclampsia, or stillbirths.
In this cross-sectional study, the prevalence of HCV-positive pregnancies increased markedly, and maternal HCV infection was associated with increased risks for adverse perinatal outcomes. These data may support recent recommendations for universal HCV screening with each pregnancy.
注射吸毒是成年人感染丙型肝炎病毒（HCV）的主要危险因素。超过三分之一的新报告 HCV 病例发生在女性中，尤其是 20 至 39 岁的人群。然而，目前全国范围内关于怀孕期间 HCV 的代表性数据有限。
评估阿片类药物流行期间 HCV 阳性妊娠的时间趋势，并确定 HCV 相关的母婴围产期结局。
设计、设置和参与者：本研究为回顾性队列研究，数据来自美国，时间范围为 1998 年至 2018 年。数据分析于 2021 年 11 月 14 日至 2023 年 5 月 14 日进行。参与者包括美国医疗保健成本和利用项目全国住院患者样本中分娩或自然流产的女性。
母体 HCV 感染。
主要结局是自 20 世纪 90 年代末阿片类药物流行开始以来，HCV 阳性孕妇的年度流行率变化，以变化衡量。次要结局是显示 HCV 感染与母婴不良事件之间关联的相对比值。
在研究期间，超过 7000 万例住院分娩或自然流产。其中，137259 例（0.20%；95%CI，0.19%-0.21%）涉及 HCV 阳性产妇；这些人更常为白人（77.4%；95%CI，76.1%-78.6%）、低收入（40.0%；95%CI，38.6%-41.5%），且更可能有吸烟（41.7%；95%CI，40.6%-42.9%）、饮酒（1.8%；95%CI，1.6%-2.0%）和阿片类药物（28.9%；95%CI，27.3%-30.6%）使用史，而非 HCV 阴性产妇。HCV 阳性产妇的中位年龄为 28.0 岁（IQR，24.3-32.2），而 HCV 阴性产妇的中位年龄为 27.2 岁（IQR，22.7-31.8）。在研究期间，HCV 阳性妊娠的流行率增加了 16 倍，2018 年达到每 1000 例妊娠中有 5.3 例（95%CI，4.9-5.7）。年龄特异性流行率增加范围从 3 倍（年龄 41-50 岁）到 31 倍（年龄 21-30 岁）。与 HCV 阳性妊娠相关的较高剖宫产、早产、胎儿生长不良或胎儿窘迫的风险。然而，妊娠糖尿病、子痫前期、子痫或死胎发生率没有显著差异。
在这项横断面研究中，HCV 阳性妊娠的流行率显著增加，而母体 HCV 感染与不良围产期结局的风险增加相关。这些数据可能支持最近关于对每次妊娠进行普遍 HCV 筛查的建议。
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