Study estimates hepatitis C infection seroprevalence in pregnant women

In a recent article published in eClinicalMedicine, researchers estimate the seroprevalence of hepatitis C virus (HCV) in pregnant women globally and in World Health Organization (WHO)-specific regions.

Study: Hepatitis C infection seroprevalence in pregnant women worldwide: a systematic review and meta-analysis. Image Credit: fotovapl / Shutterstock.com

Background

Mother-to-child/vertical transmission (MTCT) is not a common HCV infection route. Yet, the incidence rate of HCV through MTCT remains as high as 10.8% among pregnant females co-infected with HCV and human immunodeficiency virus (HIV).

Worldwide, HCV infections among pregnant women increase the risk of maternal fatalities, as well as certain complications, including premature contractions, preterm delivery, and vaginal bleeding. Furthermore, studies suggest that the infants of HCV-infected mothers experience low birth weight, intrauterine fetal death, and are often small for gestational age.

Health agencies like the Infectious Diseases Society of America (IDSA) advocate the use of direct-acting antiviral agents (DAA) on a case-by-case basis; however, risk-based HCV screening in women of reproductive age and pregnant women is uncommon, especially in low- and middle-income (LMIC) countries.

About the study

The researchers searched several databases for systematic reviews and meta-analysis studies on HCV prevalence in pregnant women between January 1, 2000, and April 1, 2023. Relevant keywords, including “hepatitis C Virus” OR “Hepatitis C” AND “pregnancy” OR “pregnant women” AND “seroprevalence” were used during the search. No systematic reviews estimating HCV seroprevalence in pregnant women were identified.

This led the researchers to subsequently extract data from observational studies reporting the prevalence of anti-HCV serum Abs or HCV seroprevalence in pregnant females or studies with adequate data to calculate these estimates.

Data on participant characteristics, study design, study site, publication date, study period, serological methods used, and related HCV risk factors were also obtained. Countries were classified according to WHO regions, human development index (HDI), and gross national income per capita.

The researchers then calculated pooled estimates of seroprevalence of HCV Ab in pregnant females at global, regional, and country levels using the DerSimonian and Laird random-effects model (REM). These results were expressed as percentages with 95% confidence intervals (CIs).

Two researchers also independently assessed the quality of all identified and eligible studies and used the Q and I2 test statistics to assess inter-study heterogeneity, in which an I2 of 75% or more indicated high heterogeneity. Sources of heterogeneity in HCV seroprevalence were determined a priori and included in subgroup and meta-regression analyses as relevant.

Study findings

This quantitative synthesis comprised 192 studies, which was equivalent to 208 seroprevalence surveys covering over 148 million pregnant women from 53 countries across six WHO-defined regions. Regarding heterogeneity, 114 and 78 studies were associated with low and moderate risk of bias, respectively, thus suggesting substantial inter-study heterogeneity with an I2 value of 99.8%. 

Of the over 148 million pregnant women included in the analysis, 486,839 were seropositive for HCV Abs, which led to an overall pooled global HCV seroprevalence of 1.80%. The estimated high burden of HCV seropositivity in pregnant females reflects an increased risk of adverse maternal and neonatal complications. 

The Eastern Mediterranean region had the highest pooled HCV seroprevalence, whereas the Western Pacific region had the lowest at 6.21% and 0.75%, respectively. Regions with moderate HCV seroprevalence included Africa, North America, the Caribbean and Latin America, and Europe at 2.35%, 2.09%, 1.62%, and 1.48%, respectively. These differences were attributed to different cultural practices, HCV testing differences, and healthcare policies.

Pakistan, Italy, Ghana, Egypt, Burkina Faso, and Cameroon had the highest pooled HCV seroprevalence rates of 9.02%, 7.18%, 4.92%, 3.89%, 3.80%, and 3.50%, respectively. Comparatively, in the United States, where HCV screening is the highest among pregnant women, HCV seroprevalence was 2.45%.

The study findings also corroborate evidence showing that drug use through injections, HIV infection, and viral co-infections contribute to HCV transmission. Accordingly, HCV seroprevalence rates were higher in women with opioid use disorder (OUD), HIV infection, and those with other complications, such as female genital cutting, as compared to general pregnant women in the sensitivity analysis.

This finding emphasizes the urgent need for global HCV prevention interventions in high-risk populations, particularly in regions with high HCV seroprevalences.

Conclusions

A multifaceted approach encompassing universal screening programs, enhanced awareness initiatives, HCV detection and testing, and access to HCV treatments is needed to achieve the WHO HCV elimination goals by 2030. This approach would also require rigorous data collection efforts, evidence-based health policies, international collaboration, resource allocation, and exploring the use of DAA agents in pregnant females.

The initial costs of HCV screening might be high; however, universal HCV screening in pregnant women is an astute investment in public health, as it is associated with significant long-term socioeconomic benefits.

Future studies are also needed to assess the safety of currently approved HCV drugs during pregnancy or the development of novel and safe-to-administer HCV drugs in pregnant women.