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Hepatitis C Goes Undetected in Children

June 20th, 2018

The opioid epidemic has many negative effects on health and society, but an often overlooked issue is the potential risk of a pregnant woman passing the hepatitis C virus (HCV) to her unborn baby. HCV is spread through contact with infected blood. The most common way to get HCV in the United States is by sharing needles or equipment used to inject illegal drugs such as heroin. While some people infected with HCV have mild symptoms or no symptoms at all, others go on to develop serious, long-term liver diseases.

At least 40,000 children are exposed to HCV during pregnancy each year, resulting in an estimated 2,700 to 4,000 new cases of HCV infections in children each year. About 80 percent of children who acquire HCV infection from their mothers develop chronic infection. Despite evidence that the number of HCV-positive women delivering babies has increased 60 percent locally and 89 percent nationally in recent years, infants are not routinely tested and many cases of HCV infections in children remain undetected, according to newly published results in the journal Pediatrics from Catherine Chappell, MD, MsC, at Magee-Womens Research Institute.

Dr. Chappell and her team reviewed information about pregnancies and deliveries at Magee-Women’s Hospital of UPMC between 2006 and 2014, and classified women as HCV-infected or HCV-uninfected. Infant records linked to the HCV-infected pregnant women were also examined. Among the 1,025 HCV-exposed infants with available pediatric records, only 96 were tested for HCV. “Without appropriate screening, children at risk for perinatal transmission may remain undiagnosed until the child becomes symptomatic or has abnormal liver enzyme testing found incidentally,” said Dr. Chappell. “Delays in diagnosis could lead to delays in appropriate referrals and curative treatment, or even irreversible liver disease, such as cirrhosis or hepatocellular carcinoma [liver cancer].”

Why aren’t more at-risk babies tested for HCV? Researchers suggest several reasons: medical providers may not fully understand a pregnant woman’s medical history due to inaccurate medical records or a woman’s fear of reporting drug use; women may be unaware of their own HCV-positive status; and women who are HCV-positive may not be adequately counseled about the risks to the unborn child. While more research needs to be done to better understand why testing rates are so low, Dr. Chappell calls the current situation “a wakeup call for providers to be aware of the increased risk of HCV in pregnant women and the effects it could have on their babies.” Dr. Chappell also proposes the development of programs focused on identifying pregnant women with HCV during prenatal care.

Interested in research studies for pregnant women? Visit pittplusme.org.

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