Few Infants Whose Moms Had Liver Disease Got Optimal Testing

Less than a third of infants born to mothers who had hepatitis C (HCV) with cirrhosis received appropriate testing, a researcher said.

Optimal HCV antibody screening was checked at age 12 months or older in only 32% of infants born to HCV-positive mothers with cirrhosis, according to a large national Canadian database, reported Tatyana Kushner, MD, of Icahn School of Medicine at Mount Sinai in New York City.

And only half of infants born to these mothers first received HCV antibody testing before they were 12 months old, she said at a presentation at the virtual annual meeting of the American Association for the Study of Liver Diseases (AASLD).

The study authors noted that the U.S. Preventive Services Task Force, the CDC, and the AASLD/Infectious Diseases Society of America now recommend universal screening for HCV during pregnancy, and there is a 5.8% risk of transmission to infants born to mothers with HCV.

At a press conference, Kushner added that when HCV is transmitted perinatally, there is a risk of liver disease in young adulthood among infants born to mothers in this population.

“In some health systems within the U.S., [these] infants are rarely followed up appropriately and receive correct testing for HCV and linkage to care. Many infants born to moms with HCV are left undiagnosed and uncared for,” she said.

Not only that, but women with HCV cirrhosis would be expected to remain under the care of a hepatitis C specialist both during and after pregnancy, but prior research shows infants born to mothers with HCV are not followed up or tested properly, Kushner and her co-authors noted.

For the study, they examined data on this population of pregnant women from 2000 to 2014, with the primary outcome of appropriate HCV infant testing — meaning an infant HCV antibody test at age 12 months or older.

Overall, there were 194 pregnancies in 151 women with active HCV at conception. The median age of these women was 32, about 60% had HCV genotype 1, and there was a median 21 months between recent HCV testing and time of conception.

Only about 25% of women with HCV were tested during pregnancy, and only 9% of women with cirrhosis were tested at that time. Of the women with cirrhosis, 31% reported having any substance use disorder, and 14% reported alcohol use disorder.

Over a third of women in this cohort had a cesarean section, 19% had a preterm delivery, and 11% had post-partum hemorrhage. The median gestational age of these infants was 38 weeks, with 13% small for gestational age and 9% large for gestational age.

But Kushner emphasized that only 42% of infants received HCV antibody screening at birth: These are “infants born to mothers with cirrhosis, so these are infants you would think … would have closer follow-up,” she said.

Of the infants with HCV antibodies checked at age 12 months or older, less than 10% of those tested had positive results. However, maternal hepatic decompensation and adverse pregnancy outcomes were not associated with appropriate infant testing, the authors noted.

Kushner emphasized the need to “identify or develop ways to improve adherence to testing guidelines … in terms of engaging mothers and healthcare providers to ensure infants receive appropriate testing.”

Last Updated November 18, 2020