title: Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: A retrospective cohort study.
abstract: BACKGROUND
  The purpose of this study was to describe the delivery of prenatal care services to women with opioid use disorder (OUD) on opioid maintenance therapy at high risk for hepatitis C virus (HCV) infection.
  
  
  METHODS
  We conducted a retrospective cohort evaluation of 791 pregnant women with OUD from 2009 to 2012. HCV screening was defined as documentation of (a) an anti-HCV antibody test or (b) a provider discussion regarding a known HCV diagnosis during pregnancy. Multivariate logistic regression was used to identify predictors of HCV screening during pregnancy.
  
  
  RESULTS
  Among 791 pregnant women with OUD, 611 (77.2%) were screened for HCV infection and 369/611 (60.4%) were HCV positive. In multivariable analysis, patients who were married (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.91), used buprenorphine (OR = 0.45; 95% CI = 0.28, 0.71), and were cared for by private practice providers (OR = 0.29; 95% CI = 0.19, 0.45) were significantly less likely to be screened. In contrast, patients who used benzodiazepines (OR = 1.72; 95% CI = 1.02, 2.92), intravenous (IV) opioids (OR = 6.15; 95% CI = 3.96, 9.56), had legal problems (OR = 2.23; 95% CI = 1.12, 4.45), had children not in their custody (OR = 1.81; 95% CI = 1.01, 3.24), and who had a partner with substance abuse history (OR = 2.38; 95% CI = 1.23, 4.59) were significantly more likely to be screened. Of 369 HCV-positive patients, a new diagnosis of HCV was made during pregnancy for 108 (29.3%) patients. Only 94 (25.5%) had HCV viral load testing, 61 (16.5%) had HCV genotype testing, and 38 (10.4%) received an immunization for hepatitis A. Although 285 (77.2%) patients were referred to hepatology, only 71 (24.9%) attended the consultation. Finally, only 6 (1.6%) patients received HCV treatment 1 year following delivery.
  
  
  CONCLUSIONS
  Prenatal care approaches to HCV infection remain inconsistent, and the majority of patients diagnosed with HCV infection during pregnancy do not receive treatment after delivery.
authors.affiliation: a Department of Obstetrics , Gynecology and Reproductive Sciences , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.|b Magee-Womens Research Institute , Pittsburgh , Pennsylvania , USA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Krans
authors.affiliation: c Center for Health Equity Research and Promotion , Veteran's Administration (VA) Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Zickmund
authors.affiliation: d Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Rustgi
authors.affiliation: d Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Seo Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: b Magee-Womens Research Institute , Pittsburgh , Pennsylvania , USA.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Dunn
authors.affiliation: e Department of General Internal Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Eleanor B
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000150:complications* / Q000188:drug therapy*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Hepatitis C virus; opioid dependence; pregnancy; prenatal care screening