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Prevalence of Maternal Hepatitis C Virus Infection in Ohio

Rossi, Robert M., MD; Warshak, Carri R., MD

doi: 10.1097/AOG.0000000000002807
Contents: Infectious Disease: Original Research

OBJECTIVE: To quantify the rising prevalence of maternal hepatitis C virus (HCV) infection in Ohio during the peak of the opioid epidemic and to identify maternal characteristics and obstetric outcomes associated with maternal HCV infection.

METHODS: We conducted a population-based retrospective cohort study of all live births in Ohio (2006–2015). Frequency of maternal HCV infection as reported on birth certificates was compared across each year of the study period. Maternal, obstetric, and neonatal characteristics were compared between women with HCV infection in pregnancy with those without HCV infection. Multivariate logistic regression estimated the relative association between HCV infection and various maternal characteristics and obstetric outcomes.

RESULTS: During the 10-year study period, there were 7,069 reported cases of maternal HCV infection at the time of delivery among 1,463,506 (0.5%) live births in Ohio. The rate of maternal HCV infection increased 631% between 2006 and 2015, from 1.6 to 11.7 cases per 1,000 live births (relative risk [RR] 7.6, CI 6.6–8.7, P<.001). After adjusting for various confounders, demographic characteristics associated with HCV infection included cigarette smoking (adjusted RR 8.6, CI 8.0–9.1), Medicaid insurance (adjusted RR 3.6, CI 3.3–3.8), and white, non-Hispanic race (adjusted RR 3.2, 95% CI 2.9–3.5). Coinfection during pregnancy with hepatitis B, gonorrhea, chlamydia, syphilis, and herpes simplex virus infection was also associated with maternal HCV infection. Obstetric and neonatal outcomes associated with maternal HCV infection included cesarean delivery, fetal intolerance of labor, preterm birth, maternal intensive care unit admission, blood transfusion, small for gestational age (less than the 10th percentile), neonatal intensive care unit admission, need for assisted neonatal ventilation, and infant death.

CONCLUSION: Maternal HCV infection has increased more than sevenfold over the past decade in Ohio. Our findings highlight a dramatic rise in maternal HCV infection that parallels the opioid epidemic within Ohio and in neighboring Appalachian states.

Maternal hepatitis C virus infection has increased more than sevenfold over the past decade in Ohio; factors associated with maternal hepatitis C virus infection include white race, low socioeconomic status, smoking, and coinfections with other sexually transmitted infections.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Corresponding author: Robert M. Rossi, MD, Department of Obstetrics and Gynecology, Clinical Associate, Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Medical Sciences Building, Room 4555, 231 Albert Sabin Way, Cincinnati, OH 45267-0526; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the Society for Maternal-Fetal Medicine's 39th Annual Pregnancy Meeting, January 29–February 3, 2018, Dallas, Texas.

This study includes data provided by the Ohio Department of Health, which should not be considered an endorsement of this study or its conclusions.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 17, 2018

Received in revised form June 07, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.