title: Sharing of Snorting Straws and Hepatitis C Virus Infection in Pregnant Women.
abstract: To evaluate possible modes of hepatitis C virus (HCV) acquisition in pregnant women found to be HCV-infected in the prenatal period and to assess transmission risk factors.
  
  
  
  This was a prospective cohort study conducted from March 2014 through June 2015 involving the distribution of an anonymous survey to HCV-infected pregnant women that assessed for numerous modes of potential HCV transmission involving, intravenous drug use, blood transfusion, organ transplant, sexual contact, tattoos, and snorting drugs with a straw. Participants were drawn from our institutional obstetric high-risk clinic. Statistical analysis involved simple percentages and χ comparisons where appropriate; P<.05 was considered significant. To test biologic plausibility, snorting utensils confiscated by law enforcement authorities from patients not in this study were tested for the presence of human blood.
  
  
  
  A total of 189 HCV-infected pregnant patients completed the survey, and no approached patients declined. Of these, 136 (72%, 95% confidence interval [CI] 65-78%) admitted to intravenous drug use, of whom 89 (65%, 95% CI 57-73%) reported sharing needles. Of the 178 (94%, 95% CI 90-97%) who admitted snorting drugs, 164 (92%, 95% CI 87-96%) reported sharing straws. The difference between the proportion reporting sharing of snorting utensils compared with the proportion sharing intravenous drug use utensils was significant (P<.001). Twenty-nine patients (15%, 95% CI 11-21%) reported snorting drugs and sharing straws but denied any other risk factor except sexual contact. Of the 54 straws confiscated by law enforcement authorities, 13 (24%, 95% CI 13-38%) tested positive for the presence of human blood.
  
  
  
  Sharing snorting utensils (straws) in noninjection drug use may be an additional risk factor for HCV and other virus transmission.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee.
authors.forename: Noelle
authors.initials: N
authors.lastname: Fernandez
authors.forename: Craig V
authors.initials: CV
authors.lastname: Towers
authors.forename: Lynlee
authors.initials: L
authors.lastname: Wolfe
authors.forename: Mark D
authors.initials: MD
authors.lastname: Hennessy
authors.forename: Beth
authors.initials: B
authors.lastname: Weitz
authors.forename: Stephanie
authors.initials: S
authors.lastname: Porter
mesh_terms: D000281:Administration, Intranasal / Q000295:instrumentation; D000328:Adult; D001769:Blood; D004866:Equipment Contamination; D005260:Female; D050456:Fomites; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D016485:Needle Sharing / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications*; D011795:Surveys and Questionnaires