Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy: A retrospective cohort study

Elizabeth E. Krans, Susan L. Zickmund, Vinod K. Rustgi, Seo Young Park, Shannon L. Dunn, Eleanor Schwarz

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalSubstance Abuse
Volume37
Issue number1
DOIs
StatePublished - Jan 2 2016
Externally publishedYes

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Virus Diseases
Hepacivirus
Opioid Analgesics
Pregnant Women
Cohort Studies
Retrospective Studies
Odds Ratio
Confidence Intervals
Therapeutics
Pregnancy
Prenatal Care
Buprenorphine
Hepatitis C Antibodies
Hepatitis A
Private Practice
Gastroenterology
Viral Load
Benzodiazepines
Documentation
Substance-Related Disorders

Keywords

  • Hepatitis C virus
  • opioid dependence
  • pregnancy
  • prenatal care screening

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy : A retrospective cohort study. / Krans, Elizabeth E.; Zickmund, Susan L.; Rustgi, Vinod K.; Park, Seo Young; Dunn, Shannon L.; Schwarz, Eleanor.

In: Substance Abuse, Vol. 37, No. 1, 02.01.2016, p. 88-95.

Research output: Contribution to journalArticle

Krans, Elizabeth E. ; Zickmund, Susan L. ; Rustgi, Vinod K. ; Park, Seo Young ; Dunn, Shannon L. ; Schwarz, Eleanor. / Screening and evaluation of hepatitis C virus infection in pregnant women on opioid maintenance therapy : A retrospective cohort study. In: Substance Abuse. 2016 ; Vol. 37, No. 1. pp. 88-95.
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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.",
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AU - Zickmund, Susan L.

AU - Rustgi, Vinod K.

AU - Park, Seo Young

AU - Dunn, Shannon L.

AU - Schwarz, Eleanor

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N2 - 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.

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