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Abstract
Background Pregnant women with hepatitis C virus (HCV) infection represent a key population in HCV elimination. While the global prevalence of HCV has declined with the introduction of DAA, both pregnant women and children aged 3 and below are being left behind in HCV elimination. This study aimed to determine the prevalence, maternal-to-child transmission (MTCT), maternal and fetal complication rates, and direct-acting antivirals (DAA) treatment outcomes of chronic HCV in pregnant women.
Methods A systematic review was performed to identify studies reporting the prevalence, MTCT, and complications of HCV infection in pregnant women. We searched five electronic databases from inception until 1st March 2024 according to our pre-specified protocol (PROSPERO: CRD42024500023). Meta-analysis was performed using random-effect models using RevMan and R.
Results We included a total of 311,905,738 pregnant women from 333 studies, the pooled global seroprevalence and viremia prevalence of HCV in pregnant women was 2.6% (95%CI: 2.0-3.2), and 1.3% (95%CI: 0.7-2.2), respectively (IDDF2024-ABS-0138 Figure 1. Hepatitis C virus seroprevalence among pregnant women by WHO region); which increased in patients with intravenous drug abuse. Most patients were diagnosed through universal screening (75%). The pooled MTCT rate among viremia HCV mothers was 9.0% (95%CI: 6.6-11.7), which was higher with HIV co-infection (OR: 3.1, 95%CI: 2.1-4.6) but not influenced by the mode of delivery or breastfeeding.
Pregnant women with HCV infection had more maternal complications, including intrahepatic cholestasis, preterm delivery, and antepartum hemorrhage. Neonates from HCV mothers had higher odds of being small for the gestational age (IDDF2024-ABS-0138 Figure 2. Maternal and neonatal complications in pregnant women with HCV infection). The pooled rate of sustained virologic response (SVR12) among the 74 women treated with DAA during pregnancy was 100%, with no serious adverse events reported.
Hepatitis C virus seroprevalence among pregnant women by WHO region
Maternal and neonatal complications in pregnant women with HCV infection
Conclusions HCV prevalence in pregnant women varies by geographic region and patient population, while MTCT occurs in almost one in ten viremic mothers. Pregnant women with HCV had a significantly higher risk of both maternal and neonatal complications. Early data suggest that DAA is safe in pregnant women with HCV infection. The majority of HCV in pregnant women were diagnosed through universal screening, suggesting that HCV screening should be offered to all pregnant women.