Pediatric Hepatitis C Screening by Maternal Hepatitis C Infection Status During Pregnancy

Screening for perinatal hepatitis C virus (HCV) infections remains low despite increases in the number of at-risk infants. It is unknown if pediatric screening varies by maternal HCV infection status during pregnancy.

Using a retrospective cohort of mother-infant pairs born from 2015 to 2019, we identified women with HCV and classified their infection status during pregnancy as active, probable, or previous based on HCV RNA testing obtained during pregnancy. We used logistic regression to assess odds ratio (OR) of infant screening based on maternal HCV infection status.

Of the 503 HCV-exposed infants, 137 (27%) were born to women with previous infection, 106 (21%) to women with probable infection, and 260 (52%) to women with active infection. Completion of pediatric screening varied by maternal infection status (43% previous infection; 49% probable infection; 58% active; P = 0.014). Pediatric HCV infection ranged from 1.7 to 7.7% by maternal viral load (VL) status. Infants born to women with active infection were 2.5 times more likely (95% confidence intervals [CI]: 1.5-4.4) to have a screening test ordered versus infants of previously infected women; there was no difference for infants of women with probable infection (OR:1.6; 95% CI: 0.9-3.2). Test ordering was also associated with maternal smoking status, a visit at ≥18 months of age, and outpatient documentation of HCV exposure. If a test was ordered, there was no difference in test completion by maternal infection status. However, test completion was associated with living with a nonbiologic parent and earlier birth year.

Infants born to women with active infection are more likely to be screened for HCV, but many children continue to be unscreened and pediatric HCV infections are going undetected. New Centers for Disease Control and Prevention pediatric HCV screening guidelines recommending earlier screening may improve screening rates.