HCV testing and postpartum treatment gaps persist among pregnant women with opioid use disorder

Despite national recommendations for universal prenatal hepatitis C virus (HCV) testing, significant gaps in both testing during pregnancy and treatment in the postpartum period persist among women with opioid use disorder (OUD), according to a cohort study published in Pregnancy.

HCV infections among young adults aged 20 to 39 years more than doubled in the United States over the past decade, rising in parallel with the opioid crisis, according to the study authors, who referenced data from the Centers for Disease Control and Prevention and the American Journal of Public Health.^1-4 The incidence of HCV infection at delivery increased 10-fold during 2000 to 2019, expanding the number of children at risk for vertical transmission. Untreated HCV infection carries significant long-term consequences, including cirrhosis, liver cancer, and death.¹

In April 2020, the CDC updated its guidance to recommend HCV testing during each pregnancy, except in settings where HCV prevalence falls below 0.1%, moving away from the prior risk-factor-based approach that had proven difficult to apply consistently. ACOG subsequently recommended HCV screening at the first prenatal visit. Early diagnosis during pregnancy allows for antenatal specialist referral to discuss postpartum treatment with direct-acting antivirals (DAAs), which are recommended for all non-pregnant individuals aged 3 years and older, and enables prerequisite testing, co-infection screening for HIV and syphilis, and vaccination for hepatitis A and B as indicated, the study authors noted.

How common were HCV testing gaps among pregnant women with OUD?

The analysis drew from the MATernaL and Infant clinical NetworK (MAT-LINK) surveillance system, a cohort of women with OUD during pregnancy collected from electronic health records at 7 healthcare systems. Women were included if they had OUD during pregnancy and a known pregnancy outcome between January 1, 2014, and August 31, 2021.

Among 5,533 pregnancies in the cohort, 1,506 (27.2%) had no HCV testing or diagnostic code, including 1,296 who received prenatal care. Among the 910 pregnancies with no prenatal care, 700 (76.9%) had HCV testing or diagnostic codes, suggesting that testing is occurring in non-traditional settings outside of routine prenatal care.

Among pregnancies with HCV testing or diagnostic codes, 55.8% had a hepatitis C diagnosis, reflecting a high burden of infection in this population.

Which factors were associated with HCV testing?

Multinomial regression revealed that women were more likely to have HCV testing if they were White or Hispanic, had government-funded insurance, or received medication for OUD during pregnancy. These associations point to persistent disparities in testing access that may compound existing health inequities in this population.

How often did women receive postpartum DAA treatment?

From 5 clinical sites with prescription information available, 9.7% (81/836) of women with a detectable viral load received a DAA prescription in the first year postpartum. This rate represents a critical gap given that postpartum DAA treatment is recommended for all eligible individuals and is curative in the majority of cases.

The findings highlight that receiving medication for OUD was associated with HCV testing during pregnancy, suggesting that medication-assisted treatment settings may represent an important access point for integrating HCV care. Improving HCV testing, postpartum treatment linkage, and comprehensive management for pregnant women with OUD represent key opportunities for improving maternal health outcomes and advancing national HCV elimination goals.

Reference:

1. Gosdin L, Miele K, Kim SY, et al. Prenatal testing and postpartum treatment for hepatitis C virus among women with opioid use disorder. Pregnancy. 2026;2(5):e70382. doi:10.1002/pmf2.70382
2. Centers for Disease Control and Prevention. 2021. 2020 Viral Hepatitis Surveillance Report. Accessed August 18 2026. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htm.
3. Ko, JY, SC Haight, SF Schillie, M K Bohm, P M Dietz. National Trends in Hepatitis C Infection by Opioid Use Disorder Status Among Pregnant Women at Delivery Hospitalization—United States, 2000–2015. MMWR Morbidity and Mortality Weekly Report 68(39): 833–8. https://doi.org/10.15585/mmwr.mm6839a1
4. Zibbell, JE, AK Asher, RC Patel,et al. Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014. American Journal of Public Health 108(2): 175–81. https://doi.org/10.2105/ajph.2017.304132