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

Area of Science:

• Hepatology
• Infectious Diseases
• Maternal-Fetal Medicine

Background:

• Hepatitis C virus (HCV) infection poses risks during pregnancy.
• Current risk-based screening may underestimate HCV prevalence in pregnant populations.
• Accurate screening is crucial for maternal and infant health outcomes.

Purpose of the Study:

• To compare the effectiveness of universal versus risk-based screening for HCV in pregnant women.
• To evaluate the prevalence of HCV infection in pregnant women using different screening strategies.
• To assess the performance of a standard obstetrician screening questionnaire for HCV risk.

Main Methods:

• Prospective observational study conducted in a high-risk inner-city clinic from January to March 2012.
• Compared HCV antibody testing in 'low risk' pregnant women (universal screening) with 'high risk' pregnant women identified via a screening questionnaire (risk-based selective screening).
• Analyzed medical records and HCV antibody test results for 419 delivering women.

Main Results:

• The overall prevalence of HCV infection was 3.18% among all tested women.
• Risk-based selective screening identified only 0.95% prevalence, significantly underestimating the actual rate.
• The screening questionnaire demonstrated a sensitivity of 0.85 but a low specificity of 0.52, indicating poor discrimination.

Conclusions:

• Risk-based screening questionnaires significantly underestimate the true prevalence of HCV infection in pregnant women.
• Universal HCV screening is recommended for pregnant women, particularly in high-prevalence urban settings.
• Implementing universal screening can improve the detection and management of HCV in this vulnerable population.