title: Antenatal screening for hepatitis C: Universal or risk factor based?
abstract: BACKGROUND
  There is no clear consensus on whether antenatal screening for hepatitis C (HCV) should be universal, or based on an assessment of risk factors.
  
  
  OBJECTIVE
  To report the HCV status and risk factors for HCV amongst women delivering at a tertiary metropolitan hospital in order to better understand the implications of changing from universal to risk factor based HCV screening.
  
  
  METHODS
  An audit of practice was performed at Mater Mothers' Hospitals (Brisbane) using routinely collected data from 2007 to 2013 (n = 57,659). The demographic and clinical characteristics of HCV-positive women (n = 281) were compared with those with a negative result (n = 57,378), and compared for the presence or absence of risk factors for HCV.
  
  
  RESULTS
  From a cohort of 57,659 women, 281 (0.5%) women were HCV positive. HCV-positive women were more likely to have received blood products (10.0 vs 3.1%; P < 0.001), have a history of illicit drug use (72.2 vs 9.8%; P < 0.001), and have at least one risk factor for HCV infection (92 vs 17%; P < 0.001). Of the HCV-positive women, only seven of the 281 (2.5%) had no identifiable risk factor, whilst most (83%) HCV-negative women did not have any documented risk factor for HCV infection.
  
  
  CONCLUSIONS
  Most women testing positive for HCV antibodies have identifiable risk factors; however, a small number will not be detected if a risk factor based screening approach is adopted. The benefits of universal screening must be weighed against the potential cost savings of a risk factor based screening program.
authors.affiliation: Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Wilson
authors.affiliation: Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.|Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Beckmann
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008485:Medical Audit; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000209:etiology; D011296:Prenatal Diagnosis / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors
keywords: Hepatitis C; mass screening; pregnancy; prenatal diagnosis; risk factors