(1221) Is detectable deleterious? Comparing maternal and neonatal factors stratified by hepatitis C viral load detection

Objective: To investigate maternal and neonatal risk factors and outcomes among pregnant individuals with positive hepatitis C virus (HCV) screening results stratified by undetectable or detectable HCV RNA or viral load (VL).

Study Design: This retrospective cohort study included all deliveries between January 2022 and June 2023 at our institution with positive HCV antibody screening results and quantitative HCV RNA testing. Data on demographics and maternal and neonatal outcomes were collected. Comparisons were performed on factors and outcomes stratified by undetectable or detectable VL. Pearson chi-square tests were used to compare populations and outcomes as appropriate and can be found in the table.

Results: Of the 6,337 births with HCV screening results, the prevalence of positive HCV screening serology was 3.6% (n=228). HCV VL results were available for 206 patients. When stratified by undetectable or detectable VL, there were no statistically significant differences in preterm delivery, hypertensive disorders of pregnancy, late or limited prenatal care, delivery route, NICU admission, or neonatal abstinence syndrome diagnosis. There were no differences in the rate of self-reported current substance misuse or a history of IV substance misuse. A history of substance misuse was significantly higher in patients with a detectable viral load (92.4% vs. 83.2%, p=.043). Full outcome data is shown in the table.

Conclusion: Although obstetric complications have been reported among women with HCV, the frequency of these outcomes remained unchanged when stratified by detectable VL. The only factor associated with detectable VL was a self-reported history of substance misuse. HCV genotyping remains an important factor in determining treatment type and duration. Future research will focus on understanding factors related to HCV infection that drive delivery and neonatal outcomes, including the temporal association of last substance use, IV misuse, and VL in pregnancy.