Risk Factors for Perinatal Transmission of Hepatitis C Virus

Prasad, Mona; Saade, George R.; Clifton, Rebecca G.; Sandoval, Grecio J.; Hughes, Brenna L.; Reddy, Uma M.; Bartholomew, Anna; Salazar, Ashley; Chien, Edward K.; Tita, Alan T. N.; Thorp, John M.; Metz, Torri D.; Wapner, Ronald J.; Sabharwal, Vishakha; Simhan, Hyagriv N.; Swamy, Geeta K.; Heyborne, Kent D.; Sibai, Baha M.; Grobman, William A.; El-Sayed, Yasser Y.; Casey, Brian M.; Parry, Samuel; Rathore, Mobeen; Diaz-Velasco, Rodrigo; Puga, Ana M.; Wiznia, Andrew; Kovacs, Andrea; Garry, David J.; Macones, George A.; ,

doi:10.1097/aog.0000000000005306

Cited by 12 publications

(5 citation statements)

References 18 publications

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“…The parent trial represents the largest cohort of patients with HCV positivity during pregnancy and included prospective collection of detailed information. 14 Use of this data set allowed us to examine multiple factors associated with breastfeeding in detail. However, 25.0% of participants in the original study were excluded due to lack of data on the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

“…This is a secondary analysis of An Observational Study of Hepatitis C in Pregnancy, a multicenter observational cohort of pregnant people with singleton gestation and HCV seropositivity, conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. 14 The IRB of The Ohio State University determined that this analysis did not require review due to use of de-identified data only.…”

Section: Methodsmentioning

confidence: 99%

“…The Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network HCV study represents the largest prospectively collected cohort of pregnant people with HCV seropositivity in the United States, along with robust follow-up data on participants and their offspring. 14 This data set offers a unique opportunity to characterize breastfeeding behaviors in this population, and may allow the design of better interventions to address barriers and increase breastfeeding rates. Thus, in this study, we sought to explore factors associated with breastfeeding initiation among people with HCV infection during pregnancy.…”

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confidence: 99%

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Breastfeeding Initiation, Duration, and Associated Factors Among People With Hepatitis C Virus Infection

Grasch,

de Voest,

Saade

et al. 2024

Obstetrics &Amp; Gynecology

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OBJECTIVE: To characterize breastfeeding behaviors and identify factors associated with breastfeeding initiation among people with hepatitis C virus (HCV) infection. METHODS: We conducted a secondary analysis of a multicenter observational cohort of pregnant people with singleton gestations and HCV seropositivity. This analysis includes individuals with data on breastfeeding initiation and excludes those with human immunodeficiency virus (HIV) co-infection. The primary outcome was self-reported initiation of breastfeeding or provision of expressed breast milk. Secondary outcomes included duration of breastfeeding. Demographic and obstetric characteristics were compared between those who initiated breastfeeding and those who did not to identify associated factors. Univariable and multivariable analyses were performed. RESULTS: Overall, 579 individuals (75.0% of participants in the parent study) were included. Of those, 362 (62.5%) initiated breastfeeding or provided breast milk to their infants, with a median duration of breastfeeding of 1.4 months (interquartile range 0.5–6.0). People with HCV viremia, defined as a detectable viral load at any point during pregnancy, were less likely to initiate breastfeeding than those who had an undetectable viral load (59.4 vs 71.9%, adjusted odds ratio [aOR] 0.61, 95% CI, 0.41–0.92). People with private insurance were more likely to initiate breastfeeding compared with those with public insurance or no insurance (80.0 vs 60.1%; aOR 2.43, 95% CI, 1.31–4.50). CONCLUSION: Although HCV seropositivity is not a contraindication to breastfeeding regardless of viral load, rates of breastfeeding initiation were lower among people with HCV viremia than among those with an undetectable viral load. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01959321.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Breastfeeding Initiation, Duration, and Associated Factors Among People With Hepatitis C Virus Infection

Grasch,

de Voest,

Saade

et al. 2024

Obstetrics &Amp; Gynecology

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“…From 2000 to 2019, hepatitis C virus (HCV) prevalence among pregnant people in the US increased 10-fold . Recent data demonstrate that HCV is transmitted in 7% to 8% of births to people with HCV . This rise in HCV infections among pregnant people is emerging as a public health concern for women and children …”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus

Curtis,

Epstein,

Pei

et al. 2024

JAMA Pediatr

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ImportancePrevalence of chronic hepatitis C virus (HCV) infection among pregnant people is increasing in the US. HCV is transmitted vertically in 7% to 8% of births. Direct-acting antiviral (DAA) therapy was recently approved for children with HCV who are 3 years or older. The clinical and economic impacts of early DAA therapy for young children with HCV, compared with treating at older ages, are unknown.ObjectiveTo develop a state-transition model to project clinical and economic outcomes for children with perinatally acquired HCV to investigate the cost-effectiveness of treating at various ages.Design, Setting, and ParticipantsThe study team modeled the natural history of perinatally acquired HCV to simulate disease progression and costs of a simulated a cohort of 1000 US children with HCV from 3 years old through death. Added data were analyzed January 5, 2021, through July 1, 2022.InterventionsThe study compared strategies offering 8 weeks of DAA therapy at 3, 6, 12, or 18 years old, as well as a comparator of never treating HCV.Main Outcomes and MeasuresOutcomes of interest include life expectancy from 3 years and average lifetime per-person health care costs. Other clinical outcomes include cases of cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).ResultsThe study team projected that treating HCV at 3 years old was associated with lower mean lifetime per-person health care costs ($148 162) than deferring treatment until 6 years old ($164 292), 12 years old ($171 909), or 18 years old ($195 374). Projected life expectancy was longest when treating at 3 years old (78.36 life years [LYs]) and decreased with treatment deferral until 6 years old (76.10 LYs), 12 years old (75.99 LYs), and 18 years old (75.46 LYs). In a cohort of 1000 children with perinatally acquired HCV, treating at 3 years old prevented 89 projected cases of cirrhosis, 27 cases of HCC, and 74 liver-related deaths compared with deferring treatment until 6 years old. In sensitivity analyses, increasing loss to follow-up led to even greater clinical benefits and cost savings with earlier treatment.Conclusions and RelevanceThese study results showed that DAA therapy for 3-year-old children was projected to reduce health care costs and increase survival compared with deferral until age 6 years or older. Measures to increase DAA access for young children will be important to realizing these benefits.

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“…In this month's issue of Obstetrics & Gynecology , Prasad et al 1 (see page 449) report data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network (MFMU) on the incidence of and risk factors for perinatal transmission of hepatitis C virus (HCV). This was a prospective, multicenter, observational study of pregnant individuals with HCV infection conducted between 2012 and 2018 in 38 participating hospitals (mostly academic) in the United States, whose primary outcome was to determine the rate of and viremic threshold for HCV perinatal transmission.…”

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confidence: 99%

A New Look at Perinatal Hepatitis C Virus Transmission

Kushner

2023

Obstetrics &Amp; Gynecology

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Risk Factors for Perinatal Transmission of Hepatitis C Virus

Cited by 12 publications

References 18 publications

Breastfeeding Initiation, Duration, and Associated Factors Among People With Hepatitis C Virus Infection

Breastfeeding Initiation, Duration, and Associated Factors Among People With Hepatitis C Virus Infection

Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus

A New Look at Perinatal Hepatitis C Virus Transmission

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