Hepatitis C virus screening in pregnancy

In 2016, the incidence of acute hepatitis C virus infection was 1.0 per 100,000 persons in the United States and 6.2 per 100,000 persons in Massachusetts. Hepatitis C virus infection among pregnant women in the United States increased by 89% from 2009 to 2014. The risk of a mother with hepatitis C virus infection transmitting the infection to her infant is approximately 4% to 7%. The Infectious Disease Society of America and the American Association for the Study of Liver Diseases recommend universal hepatitis C virus screening in pregnancy, whereas the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend risk-based screening.

The objective of this quality improvement project was to assess the hepatitis C virus screening practices of obstetricians and gynecologists at a tertiary care center located in a high endemic area for hepatitis C virus infection.

An electronic 10-question survey was reviewed by the Tufts Medical Center Institutional Review Board and found to be exempt from institutional review board approval. The survey was emailed to resident and attending physicians who provide obstetrical care.

Of a total of 41 respondents, 38 (92.6%) provided responses; of these 38 respondents, 17 (44.7%) were attending physicians, 4 (10.5%) were fellows, and 17 (44.7%) were resident physicians. In addition, 16 of 37 (43.2%) respondents answered that all pregnant women should be screened for hepatitis C virus, whereas 20 of 37 (54.1%) respondents thought only pregnant women with risk factors for hepatitis C virus infection should be screened. Furthermore, only 13 of 31 (41.9%) respondents correctly identified all of the recommended risk factors that should prompt screening for hepatitis C virus. When asked about their clinical practice, 5 of 36 (13.9%) respondents indicated that they screen all pregnant patients, whereas 28 of 36 (77.8%) respondents indicated that they screen patients based on their risk factors for hepatitis C virus infection.

Our survey showed that risk-based screening for hepatitis C virus may be less effective than universal screening because healthcare providers are not consistent in identifying risk factors for hepatitis C virus infection. Universal screening could decrease the amount of hepatitis C virus infections that go undiagnosed in pregnancy.