HCV RNA and Bleeding Predict Perinatal Transmission

TOPLINE:

Maternal hepatitis C virus (HCV) RNA titer > 10⁶ International Units (IU)/mL and antepartum bleeding are key predictors of perinatal transmission, with the risk ranging from 1.5% to 28.5%. The prediction model achieved an area under the curve of 0.76 for perinatal transmission.

METHODOLOGY:

A secondary analysis included 432 HCV antibody–positive pregnant participants enrolled in a multicenter observational study conducted between 2012 and 2018.
Researchers defined perinatal transmission as offspring demonstrating HCV RNA at age 2-6 months or testing HCV RNA or HCV antibody–positive at age 18-24 months.
Analysis focused on potential risk factors assessable before neonatal discharge, including maternal demographics, delivery characteristics, and neonatal baseline data.
Bootstrap resampling method with 1000 samples was utilized for internal validation of prediction models, with final model selection on the basis of goodness of fit and predictive ability.

TAKEAWAY:

Among study participants, the perinatal transmission rate of HCV infection was 6.0% (95% CI, 4.0%-8.7%).
Maternal HCV RNA titer > 10⁶ IU/mL showed an adjusted odds ratio (OR) of 8.2 (95% CI, 3.2-21.4) for perinatal transmission.
Antepartum bleeding demonstrated an OR of 3.3 (95% CI, 1.3-8.0) for perinatal transmission.
The area under the curve for the prediction model was 0.76 (95% CI, 0.67-0.86), indicating moderate classification ability.

IN PRACTICE:

“Universal screening in pregnancy likely will identify more pregnant individuals with positive HCV antibodies than the previously recommended risk-based screening. A potential ramification of increased identification of cases is an individual’s desire to know their risk of perinatal transmission. Our results provide data to aid in clinical counseling of pregnant individuals with positive HCV antibodies,” wrote the authors of the study.

SOURCE:

The study was led by Grecio Sandoval, PhD, George Washington University Biostatistics Center in Washington, DC. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

According to the authors, external validation of the prediction model is needed. The study was also limited by a rate of loss to follow-up that reflects clinical reality, though a bootstrap approach was used to develop a parsimonious model that captures factors most likely to be included.

DISCLOSURES:

The study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Brenna Hughes disclosed receiving payments from Moderna and UpToDate. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.