title: Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective.
abstract: BACKGROUND
  the Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist, midwifery-led service providing pregnancy care to women dealing with alcohol and other drug (AOD) use, at the sole tertiary maternity hospital in Western Australia.
  
  
  OBJECTIVE
  to assess the antenatal, intrapartum and neonatal outcomes of women with Hepatitis C (HCV) who attended the WANDAS service between 2009 and 2012.
  
  
  METHODS
  this retrospective cohort study used data obtained from computerised midwifery records. Univariate comparisons between those who were HCV positive and those who were not, were performed. Multivariable logistic regression was utilised to investigate the simultaneous factors associated with being HCV positive and an opiate user.
  
  
  RESULTS
  the incidence of HCV in this cohort was 37% (213 of 570). Compared to those who were HCV negative those who were positive were more likely to: be older (P<0.001); use opioids in pregnancy (P<0.001); be an intravenous drug user (P<0.001); engage in polysubstance use (P<0.001); and receive an induction of labour (P=0.036). There were no intrapartum characteristics found to be significant at a multivariate level associated with being HCV positive and an opiate user, but there were a couple of neonatal complications. These were having a baby admitted to Special Care Nursery (OR 1.95, 95% CI 1.33-2.88, P<0.001) and a baby at increased risk of being diagnosed with neonatal abstinence syndrome (OR 3.40, 95% CI 2.24-5.15, P<0.001).
  
  
  CONCLUSIONS
  our findings highlight the complexity of caring for pregnant women who are HCV positive, they also highlight that all pregnant women who are AOD users are an at risk population.
  
  
  CONCLUSIONS
  these results improve our understanding of the obstetric and midwifery issues associated with caring for pregnant women who are HCV positive and the value of provision of specialist care from a multidisciplinary team, led by a consultant midwife.
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: angela.o'connor@health.wa.gov.au.
authors.forename: Angela
authors.initials: A
authors.lastname: O'Connor
authors.affiliation: School of Nursing and Midwifery, Curtin University, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: Lucy.Lewis@health.wa.gov.au.
authors.forename: Lucy
authors.initials: L
authors.lastname: Lewis
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: Renate.McLaurin@health.wa.gov.au.
authors.forename: Renate
authors.initials: R
authors.lastname: McLaurin
authors.affiliation: King Edward Memorial Hospital, Subiaco, Western Australia, Australia. Electronic address: Lisa.barnett@curtin.edu.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Barnett
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D006526:Hepatitis C / Q000451:nursing* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000451:nursing*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous; D014904:Western Australia; D055815:Young Adult
keywords: Drug and alcohol use in pregnancy; Hepatitis in pregnancy; Midwifery led care