Abstract
Objectives
We investigated the relationship between maternal hepatitis C virus (HCV) infection and infant health. Furthermore, we evaluated racial disparities with these associations.
Methods
Using 2017 US birth certificate data, we investigated the association between maternal HCV infection and infant birthweight, preterm birth, and Apgar score. We used unadjusted and adjusted linear regression and logistic regression models. Models were adjusted for use of prenatal care, maternal age, maternal education, maternal smoking status, and the presence of other sexually transmitted infections. We stratified the models by race to describe the experiences of White and Black women separately.
Results
Maternal HCV infection was associated with reduced infant birthweight on average by 42.0 g (95% CI: -58.81, -25.30) for women of all races, 64.6 g (95% CI: -81.91, -47.26) for White women and 80.3 g (95% CI: -162.48, 1.93) for Black women. Women with maternal HCV infection had increased odds of having a preterm birth of 1.06 (95% CI: 0.96, 1.17) for women of all races, 1.06 (95% CI: 0.96, 1.18) for White women and 1.35 (95% CI: 0.93, 1.97) for Black women. Overall, women with maternal HCV infection had increased odds 1.26 (95% CI: 1.03, 1.55) of having a low/intermediate Apgar score; White and Black women with HCV infection had similarly increased odds of an infant with low/intermediate Apgar score in a stratified analysis: 1.23 (95% CI: 0.98, 1.53) for White women and 1.24 (95% CI: 0.51, 3.02) for Black women.
Conclusions
Maternal HCV infection was associated with lower infant birthweight and higher odds of having a low/intermediate Apgar score. Given the potential for residual confounding, these results should be interpreted with caution.
Significance
HCV is the most common blood-borne infection in the US and maternal cases of HCV has increased in recent years. The adverse impact of maternal HCV on newborn health is not fully known with mixed reports on the risk of low birthweight and low Apgar score and, generally, an increased risk for preterm birth. Our study utilized US birth certificates from 2017 and observed maternal HCV was associated with lower birthweight and low/intermediate Apgar score (among term infants). No association was observed between maternal HCV and preterm birth. We observed some evidence for racial disparities between Black and White women for many of these outcomes.
Similar content being viewed by others
References
Armstrong, G. L., Wasley, A., Simard, E. P., McQuillan, G. M., Kuhnert, W. L., & Alter, M. J. (2006). The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Annals Of Internal Medicine, 144(10), 705–714.
Averhoff, F. M., Glass, N., & Holtzman, D. (2012). Global burden of hepatitis C: Considerations for healthcare providers in the United States. Clinical Infectious Diseases, 55, S10–15. https://doi.org/10.1093/cid/cis361.
Bell, R., Wolfe, I., Cox, D., Thakarar, K., Lucas, L., & Craig, A. (2019). Hepatitis C screening in mothers and infants exposed to Opioids. Hosp Pediatr, 9(8), 639–642. https://doi.org/10.1542/hpeds.2018-0225.
CDC. (2016). Facility Worksheet for the live birth certificate. https://www.cdc.gov/nchs/data/dvs/facility-worksheet-2016.pdf
CDC. (2017). User guide to the 2017 Natality Public Use file. CDC.
CDC. (2019). Viral Hepatitis Surveillance—United States, 2017. US Department of Health and Human Services. https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm
Chak, E., Talal, A. H., Sherman, K. E., Schiff, E. R., & Saab, S. (2011). Hepatitis C virus infection in USA: An estimate of true prevalence. Liver International: Official Journal Of The International Association For The Study Of The Liver, 31(8), 1090–1101. https://doi.org/10.1111/j.1478-3231.2011.02494.x.
Chappell, C. A., Scarsi, K. K., Kirby, B. J., Suri, V., Gaggar, A., Bogen, D. L., & Hillier, S. L. (2020). Ledipasvir plus sofosbuvir in pregnant women with hepatitis C virus infection: A phase 1 pharmacokinetic study. Lancet Microbe, 1(5), e200–e208. https://doi.org/10.1016/s2666-5247(20)30062-8.
Cnattingius, S., Johansson, S., & Razaz, N. (2020). Apgar score and risk of neonatal death among Preterm Infants. New England Journal Of Medicine, 383(1), 49–57. https://doi.org/10.1056/NEJMoa1915075.
Connell, L. E., Salihu, H. M., Salemi, J. L., August, E. M., Weldeselasse, H., & Mbah, A. K. (2011). Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver International: Official Journal Of The International Association For The Study Of The Liver, 31(8), 1163–1170. https://doi.org/10.1111/j.1478-3231.2011.02556.x.
Denniston, M. M., Jiles, R. B., Drobeniuc, J., Klevens, R. M., Ward, J. W., McQuillan, G. M., & Holmberg, S. D. (2014). Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Annals Of Internal Medicine, 160(5), 293–300.
Durham, D. P., Skrip, L. A., Bruce, R. D., Vilarinho, S., Elbasha, E. H., Galvani, A. P., & Townsend, J. P. (2016). The impact of enhanced screening and treatment on Hepatitis C in the United States. Clinical Infectious Diseases, 62(3), 298–304.
Ely, D. M., & Driscoll, A. K. (2019). Infant Mortality in the United States, 2017: Data From the Period Linked Birth/Infant Death File.
Espinosa, C. M., & Jhaveri, R. (2018). Update on the management of hepatitis B and C infections in the neonatal period. Seminars In Perinatology, 42(3), 185–190. https://doi.org/10.1053/j.semperi.2018.02.006.
Govrin-Yehudain, Y., Wainstock, T., Abu-Freha, N., & Sheiner, E. (2019). Maternal hepatitis B virus and hepatitis C virus carrier status during pregnancy and long-term respiratory complications in the offspring. Early Human Development, 140, 104904. https://doi.org/10.1016/j.earlhumdev.2019.104904.
Greenland, S., Pearl, J., & Robins, J. M. (1999). Causal diagrams for epidemiologic research. Epidemiology (Cambridge, Mass.), 10, 37–48.
Hofmeister, M. G., Rosenthal, E. M., Barker, L. K., Rosenberg, E. S., Barranco, M. A., Hall, E. W., & Ryerson, A. B. (2019). Estimating prevalence of Hepatitis C virus infection in the United States, 2013–2016. Hepatology, 69(3), 1020–1031.
Huang, Q. T., Huang, Q., Zhong, M., Wei, S. S., Luo, W., Li, F., & Yu, Y. H. (2015). Chronic hepatitis C virus infection is associated with increased risk of preterm birth: A meta-analysis of observational studies. J Viral Hepat, 22(12), 1033–1042. https://doi.org/10.1111/jvh.12430.
Jaffery, T., Tariq, N., Ayub, R., & Yawar, A. (2005). Frequency of hepatitis C in pregnancy and pregnancy outcome. J Coll Physicians Surg Pak, 15, 716–719. https://doi.org/11.2005/jcpsp.716719.
Kim, N. J., Holguin, D., Bush, D., & Khalili, M. (2019). Hepatitis C screening in an Underserved U.S. Cohort of Reproductive Age Women. Hepatol Commun, 3(9), 1183–1190.
Kohli, A., Shaffer, A., Sherman, A., & Kottilil, S. (2014). Treatment of hepatitis C: A systematic review. Journal Of The American Medical Association, 312, 631–640. https://doi.org/10.1001/jama.2014.7085.
Lingala, S., & Ghany, M. G. (2015). Natural history of Hepatitis C. Gastroenterol Clin North Am, 44(4), 717–734. https://doi.org/10.1016/j.gtc.2015.07.003.
Martin, J. A., Osterman, M. J., Kirmeyer, S. E., & Gregory, E. C. (2015). Measuring gestational age in vital Statistics Data: Transitioning to the Obstetric Estimate. National Vital Statistics Reports: From The Centers For Disease Control And Prevention, National Center For Health Statistics, National Vital Statistics System, 64(5), 1–20.
Nolen, L. D., Gustin, C., Seeman, S., Murphy, N., Truitt, S., Schillie, S., & McMahon, B. (2019). Risk-Based Prenatal Hepatitis C Testing Practices and Results, Alaska 2013–2016. Can J Gastroenterol Hepatol, 2019, 8654741.
Nunez-Smith, M., Bradley, E. H., Herrin, J., Santana, C., Curry, L. A., Normand, S. L., & Krumholz, H. M. (2011). Quality of care in the US territories. Archives Of Internal Medicine, 171(17), 1528–1540.
Nuti, S. V., Wang, Y., Masoudi, F. A., Nunez-Smith, M., Normand, S. T., Murugiah, K., & Krumholz, H. M. (2017). Quality of care in the United States Territories, 1999–2012. Medical Care, 55(10), 886–892.
Patrick, S. W., Bauer, A. M., Warren, M. D., Jones, T. F., & Wester, C. (2017). Hepatitis C virus infection among women giving birth - Tennessee and United States, 2009–2014. Mmwr. Morbidity And Mortality Weekly Report, 66(18), 470–473. https://doi.org/10.15585/mmwr.mm6618a3.
Pergam, S. A., Wang, C. C., Gardella, C. M., Sandison, T. G., Phipps, W. T., & Hawes, S. E. (2008). Pregnancy complications associated with hepatitis C: data from a 2003–2005 Washington state birth cohort. Am J Obstet Gynecol, 199(1), 38 e31-39.
Prather, C., Fuller, T. R., Jeffries, W. L., t., Marshall, K. J., Howell, A. V., Belyue-Umole, A., & King, W. (2018). Racism, african American Women, and their sexual and Reproductive Health: A review of historical and contemporary evidence and implications for Health Equity. Health Equity, 2(1), 249–259.
Rossi, R. M., Wolfe, C., Brokamp, R., McAllister, J. M., Wexelblatt, S., Warshak, C. R., & Hall, E. S. (2020). Reported prevalence of maternal Hepatitis C virus infection in the United States. Obstetrics And Gynecology, 135(2), 387–395. https://doi.org/10.1097/aog.0000000000003644.
Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A. B. (2020). CDC Recommendations for Hepatitis C screening among adults - United States, 2020. Mmwr. Recommendations And Reports: Morbidity And Mortality Weekly Report. Recommendations And Reports / Centers For Disease Control, 69(2), 1–17.
Seeff, L. B. (2002). Natural history of chronic hepatitis C. Hepatology, 36, 35–46. https://doi.org/10.1053/jhep.2002.36806.
Stokkeland, K., Ludvigsson, J. F., Hultcrantz, R., Ekbom, A., Hoijer, J., Bottai, M., & Stephansson, O. (2017). Pregnancy outcome in more than 5000 births to women with viral hepatitis: A population-based cohort study in Sweden. European Journal Of Epidemiology, 32(7), 617–625.
Tasillo, A., Eftekhari Yazdi, G., Nolen, S., Schillie, S., Vellozzi, C., Epstein, R., & Linas, B. P. (2019). Short-term Effects and Long-Term cost-effectiveness of Universal Hepatitis C testing in prenatal care. Obstetrics And Gynecology, 133(2), 289–300.
Watts, T., Stockman, L., Martin, J., Guilfoyle, S. M., Vergeront, J. M., & Zahner, S. (2019). Estimates of prenatal HIV, Hepatitis B Virus, and Hepatitis C Virus Testing among pregnant people enrolled in Wisconsin Medicaid, 2011–2015. Maternal And Child Health Journal. https://doi.org/10.1007/s10995-019-02841-1.
Williams, M. A. (2011). Pregnancy complications. In G. M. Buck, Louis, & R. W. Platt (Eds.), Reproductive and Perinatal Epidemiology (pp. 101–128). Oxford University Press.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author(s) report(s) no conflict of interest.
Paper Presentation Information
None to disclose.
Disclaimer
None to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Hood, R.B., Miller, W.C., Shoben, A. et al. Maternal Hepatitis C Virus Infection and Adverse Newborn Outcomes in the US. Matern Child Health J 27, 1343–1351 (2023). https://doi.org/10.1007/s10995-023-03666-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03666-9