Expanded hepatitis C screening guidelines sparked a jump in testing among pregnant women, but uptake has nonetheless been too low, according to findings published in JAMA. With a majority of pregnant women remaining untested, researchers highlight a key avenue to help eliminate the virus.

Over time, chronic hepatitis C virus (HCV) infection can cause serious liver complications, including cirrhosis and liver cancer. HCV, a bloodborne virus, can be transmitted from mother to child during pregnancy or delivery. Hepatitis C prevalence among pregnant women has risen steeply in recent decades. Modern direct-acting antiviral therapy can cure more than 90% of patients, so prompt testing and treatment are more important than ever.

In 2020, the Centers for Disease Control and Prevention (CDC) updated its guidelines to recommend that all adults should undergo HCV screening at least once, and women should be tested during every pregnancy.

Rachel Epstein, MD, of Boston University Chobanian & Avedisian School of Medicine, and colleagues assessed differences in HCV screening rates between pregnant and nonpregnant women. They accessed electronic health records from the TriNetX LIVE system, with data from 115,490,864 individuals across 68 healthcare organizations in the United States. However, as 65% of these institutions are in the Northeast or South, it was not a nationally representative sample.

The researchers included women between the ages of 15 and 45 who attended a medical visit during a six-month period from January 2014 to December 2019 and from July 2020 to December 2022. The final study population comprised 759,591 pregnant women and 24,066,400 nonpregnant women.

During the course of the study, there were records for 79,231 HCV tests for pregnant women and 678,951 tests for nonpregnant women. From 2014 to 2019, HCV screening rates more than doubled among pregnant women, from 52 to 117 tests per 1,000 person-years. Screening also rose among nonpregnant women, from 16 to 24 tests per 1,000 person-years.

After the screening guidelines changed, HCV testing rates rose significantly. Among pregnant women, screening increased from 141 to 253 tests per 1,000 person-years. For nonpregnant women, it went up from 29 to 37 tests per 1,000 person-years.

By December 2022, 39% of pregnant women had been tested for HCV, compared to just 9% of nonpregnant women. While pregnant women were much more likely than nonpregnant women to be screened for hepatitis C, the testing rate is still quite low. In comparison, 91% of pregnant women underwent screening for HIV.

“The increasing but suboptimal HCV screening suggests innovative strategies are needed to improve HCV diagnosis and treatment,” wrote the researchers. “Perinatal care is a unique health care touchpoint and could be a key time to implement the national HCV elimination plan.”

Click here for more news about hepatitis C.