Hepatitis C Rising Among Pregnant Women in Rural Counties

About 1 in every 50 West Virginia infants is exposed to the virus at birth.

The rate of Hepatitis C virus (HCV) infections in pregnant women nearly doubled from 2009 to 2014, which a study links to the national opioid epidemic.

HCV, now the country’s most common bloodborne infection with an estimated 3.5 million patients, has been become a major issue in pregnant women due to injection drug use, according to a study by Vanderbilt University Medical Center Pediatrics and Health Policy assistant professor Stephen Patrick, MD.

The study, coauthored by the Tennessee Department of Health, found the virus is especially prevalent in rural regions of states such as Tennessee and West Virginia—the latter reporting an infant birth infection rate of 22.6 for every 1000 live births in 2014.

Patrick noted that rate comes out to 1 in every 50 West Virginian infants being exposed to HCV.

“We have seen a dramatic increase in opioid use in pregnancy and in the number of infants having drug withdrawal,” Patrick said.

In Tennessee, about 1 in every 100 infants were born with the virus, although Patrick noted up to 8% of pregnant women in some counties were documented as having HCV at the time of their delivery.

“We found that rural and Appalachian counties were particularly impacted by the virus,” he said.

An at-birth HCV infection was about 3 times as more likely for Tennessee women in rural counties, 4.5 times as likely for women who smoked during pregnancy, and about 17 times more likely for women with concurrent hepatitis B virus infection.

What’s needed to limit the widespread increases of infections is more efforts in preventing and expanding treatment for opioid-use disorder, Patrick said. He emphasized a need for women to have access to virus and testing treatment, and to attempt to clear the virus before becoming pregnant.

There’s also an importance in monitoring infants exposed to HCV at birth, Patrick said.

“We need to build systems of care to ensure that all infants exposed to the virus are adequately followed,” he said.

Tennessee Department of Health state epidemiologist Tim Jones, MD, called the study an important reminder of the growing opioid epidemic’s threat to high-risk populations.

“While this study focuses on pregnant women and a high-risk area in Tennessee, it is also important to remember that hundreds of thousands of people throughout the US have hepatitis C, and a large percentage of them do not know it,” Jones said.

He advised that anyone born before 1964 or to have ever used intravenous therapy drugs should discuss the appropriateness of testing for the virus with their clinician.

The study appeared May 11 in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

A press release referencing the research was made available.

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