Although hepatitis C screening rates for pregnant people have increased since the advent of new guidelines recommending universal screening during each pregnancy, less than half received the recommended tests in early 2021, according to study results published in Obstetrics and Gynecology. People insured through Medicaid were even less likely to be screened.
“Our Health Trends study underscores the power of medical guidelines to favorably influence screening rates for diseases such as hepatitis C,” Harvey Kaufman, MD, senior medical director for Quest Diagnostics in Secaucus, New Jersey, said in a press release. “Yet it also reveals that gaps in guideline-based care are prevalent and highlights the urgent need to close them in underserved populations. We hope our research brings attention to quality gaps in maternal health in the United States and the importance of ensuring pregnant people are screened for HCV and other diseases that jeopardize their health and that of their newborns."
Hepatitis C is rising among pregnant people and people of childbearing age in the United States in conjunction with the ongoing opioid epidemic. Sharing needles and other drug-injection equipment is a major route of hepatitis C virus (HCV) transmission, and pregnant people can transmit the virus to their infants during gestation or delivery.
“For more than a decade, the opioid crisis has been associated with dramatic increases in hepatitis C among people of reproductive age in the United States, making screening among pregnant people critical to addressing this epidemic," Carolyn Wester, MD, MPH, director of the Centers for Disease Control and Prevention (CDC) Division of Viral Hepatitis, said in the press release.
Traditionally, hepatitis C testing during pregnancy was recommended for those with known risk factors, but the CDC, the American Association for the Study of Liver Diseases and the American College of Obstetrics and Gynecology now recommend universal screening as part of routine prenatal care.
In March 2020, the CDC and the U.S. Preventative Services Task Force (UPSTF) published guidelines recommending that all adults ages 18 to 79 be screened for HCV at least once and that people be screened during pregnancy, regardless of risk factors. The Affordable Care Act requires private insurers and Medicaid to fully cover USPSTF-recommended preventive services.
Kaufman and his colleagues assessed the impact of the 2020 recommendations on HCV testing during pregnancy. The study population consisted of 5,048,428 pregnant people between ages 15 and 44. Three quarters had commercial health insurance, and 25% were covered by Medicaid.
The participants received Quest Diagnostics’ obstetric testing panel. Overall, across the study population, 23% had an HCV screening test. But during the 2011 to 2021 study period, the screening rate rose by 145%, from 17% at the beginning to 41% at the end. Although the increase in screening accelerated following the change in guidelines in early 2020, only a minority of pregnant people received the recommended tests.
What’s more, “[d]isparities in HCV testing by health insurance status were substantial over the entire study period,” the researchers wrote. Across the study period, people with commercial insurance had a higher screening rate than those on Medicaid (25% versus 18%). From 2011 to 2012, the two groups had similar screening rates, but beginning in 2016, those covered by Medicaid were tested 25% to 35% less often than those with commercial insurance.
“It’s heartening to see an early increase in testing among pregnant people following our updated screening recommendations in 2020. However, we still have a long way to go given that less than half of mothers are receiving the recommended hepatitis C screening,” said Wester. “And just as importantly, we must work to make sure those who are diagnosed are connected to postnatal treatment and cured of hepatitis C—otherwise, we are missing a critical opportunity to improve the health of mothers in this country.”
Click here to read the study in the journal Obstetrics and Gynecology.
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