Overall, hepatitis C infections in pregnancy are relatively rare. Researchers examined data on more than 39 million people who had pregnancies between 2009 and 2019 and found that only 138,343 of them — just 0.4 percent — were diagnosed with hepatitis C. But over this period, hepatitis C infection rates among pregnant people climbed from 1.8 to 5.1 cases for every 1,000 live births, the study found. Some groups of pregnant people were especially vulnerable. Those without a college degree were more than three times more likely to develop hepatitis C. And compared with Black people, white individuals and those who identify as American Indian or Alaska Native were more than seven times more likely to have hepatitis C while pregnant. Most of these infections are caused by the use of needles contaminated with hepatitis C to inject opioids, says the study’s lead study author, Stephen Patrick, MD, MPH, the director of the Vanderbilt Center for Child Health Policy and an attending neonatologist at Vanderbilt Children’s Hospital in Nashville, Tennessee. “Our path towards improving outcomes for people affected by hepatitis C and other opioid-related complications has to be comprehensive,” Dr. Patrick says. “It needs to address many of the social needs we found were risks of hepatitis C in our study, including improving education for individuals and opportunities for employment in communities.” One limitation of the study is that it relied on data from birth certificates to identify hepatitis C cases, and not all states included this information on birth certificates a decade ago. The study also wasn’t designed to determine whether or how certain risk factors for hepatitis C, such as limited education or belonging to certain racial or ethnic groups, might increase a person’s risk of contracting the virus.
Hepatitis C Rises With Opioid Use
The surge in hepatitis C cases diagnosed among pregnant people mirrors a spike in cases of opioid use disorder. A study published in January 2021 in JAMA tracked labor and delivery hospitalizations from 2000 to 2017 at hospitals in 47 states and the District of Columbia. At the start of the study period, there were 3.5 cases of maternal opioid use disorder for every 1,000 labor and delivery admissions. By the final year, there were 8.2 cases per 1,000 admissions. These cases also appear to rise in lockstep with unemployment and the lack of accessible or affordable healthcare — systemic issues that are much more likely to negatively impact people without college degrees, Patrick says. For example, a study published in January 2019 in JAMA examined data on more 6.3 million births, including 47,000 cases of neonatal abstinence syndrome (when babies have withdrawal symptoms resulting from opioid exposure in the womb). People in communities with the highest unemployment rates were 11 percent more likely to deliver babies with neonatal abstinence syndrome, this study found. And people in areas with the worst shortages of mental health providers were 17 percent more likely to have babies with neonatal abstinence syndrome. Opioid overdose deaths also surged to a record high in 2020 as the COVID-19 pandemic exacerbated social conditions like unemployment and lack of healthcare that contribute to these fatalities. Nationwide, a total of more than 75,000 people died of opioid overdoses in the 12-month period ending in April 2021, up from about 56,000 fatalities the previous year, according to the Centers for Disease Control and Prevention (CDC). “When you see opioid overdoses climbing, it’s not a surprise to also see increases in hepatitis C,” says Steffanie Strathdee, PhD, the associate dean of global health sciences and an infectious-disease expert at the University of California in San Diego School of Medicine.
‘Failure on Multiple Levels’
“What’s shocking is to see how bad the situation is, because we actually know what to do to prevent hepatitis C — and to treat hepatitis C and opioid addiction,” says Dr. Strathdee, who wasn’t involved in the new study on hepatitis C in pregnancy. “It’s a failure on multiple levels.” Antiviral therapy for hepatitis C can cure more than 90 percent of acute cases, typically within 8 to 12 weeks, according to the CDC. People need treatment before they conceive, however, because these medications aren’t approved for use during pregnancy. Luckily, transmission to an unborn child is unlikely: Only about 6 babies out of every 100 born to a mother with hepatitis C will contract the virus, but this risk is greater if the mother also has HIV, according to the American College of Obstetricians and Gynecologists. RELATED: Hepatitis C During Pregnancy: What You Need to Know
Barriers to Opioid Use Disorder Treatment During Pregnancy
The gold standard treatment for opioid use disorder, buprenorphine, curbs cravings and reduces withdrawal symptoms — and also helps prevent overdose deaths if people relapse. The CDC recommends this treatment for pregnant people with opioid use disorder. But stigma prevents many patients who need treatment for opioid use disorder from getting it, and this is particularly true for pregnant people, Strathdee says. “In general, the U.S. responds to drug use by criminalizing it and putting people in jail instead of treating it as a medical problem,” Strathdee says. People who are pregnant may not seek treatment for opioid use disorder because they’re worried they could go to jail or have their children taken away, Strathdee says. When pregnant people do seek help, there are very few treatment programs that can help pregnant people or people with children, Strathdee adds. “To me the bottom line is that the onus of responsibility here shouldn’t be on the woman,” Strathdee says. “The medical and public health system should be able to deliver health services in a way that doesn’t stigmatize them and make the problem worse.” If you or someone you know is seeking treatment for opioid use during pregnancy, you can search for a provider anonymously and confidentially through SAMHSA, the U.S. Substance Abuse and Mental Health Service Administration.
