Hepatitis C Virus universal screening versus risk based selective screening during pregnancy

We sought to compare the value of HCV universal screening versus risk-based selective screening in pregnant women.

In a prospective observational study (Jan 2012 - March 2012), pregnant women, in a high risk inner city clinic, who were at "low risk" for HCV infection were tested for HCV antibodies (universal screening) and their medical records were compared to the medical records of pregnant women who were at "high risk" (risk based selective screening as assessed by their obstetricians' screening questionnaire).

During the study period, 419 women delivered at our institution with 8.8% (37/419) at high risk for HCV. In 95% (183/193) of available and consenting low risk women, HCV antibody testing was done. The prevalence of HCV was 3.18% (7/220; 95% CI: 1.36-6.50) in all tested women versus 0.95% (4/419; 95% CI: 0.31-2.59) in risk-based selectively tested women. Overall the screening questionnaire had a sensitivity of 0.85 (0.42-0.99) and a specificity of 0.52 (0.45-0.58) in all women who had HCV antibody testing and questionnaire screening.

Using a screening questionnaire to identify women at risk for HCV infection during pregnancy under-estimates the real prevalence of HCV. A universal screening should be considered in high risk cities.