P3.F103: Comparing Pregnancies Affected by Hepatitis C in Rural and Urban Counties, Pennsylvania, January 2018-December 2021– Surveillance of Emerging Threats to Pregnant People and Infants Network

Background: New hepatitis C virus (HCV) infections are more common among people of childbearing age than in the past, reflecting the impact of the opioid epidemic and increasing injection drug use (IDU). Rural communities have been disproportionally affected by the opioid epidemic. The Pennsylvania Department of Health, with support of CDC’s Surveillance for Emerging Threats to Pregnant People and Infants Network, has collected enhanced perinatal HCV surveillance data since 2019. We summarized data collected to date to compare outcomes in rural and urban Pennsylvania.

Methods: We defined a gestational parent as a pregnant person who was HCV RNA positive during pregnancy, or one year prior to pregnancy, without evidence of HCV clearance. To identify pregnancies, Pennsylvania residents aged 10-50 years with a positive HCV RNA test were matched with birth certificate data from January 2018-December 2021. Medical record abstraction was completed for pregnancies in Allegheny (urban) and Washington (rural) counties.

Results: A total of 481 pregnancies resulting in 475 live births were identified in Allegheny and Washington counties. Of the 481 pregnancies, 100 (20.8%) had a gestational parent residing in Washington County. Incidence of perinatal HCV exposure per 1000 live births was 1.7 times higher in Washington vs. Allegheny County. In Washington County, 93 (97%) gestational parents were white non-Hispanic, compared to 349 (93%) in Allegheny. Any lifetime IDU was reported by 90% of gestational parents in both counties. More individuals in Allegheny received Medication for Opioid Use Disorder (MOUD) during pregnancy (63%) than in Washington (57%). More individuals in Allegheny ever received HCV treatment (6.1% vs. 4.2%). More individuals in Washington received prenatal care (96% vs. 93%). In observed live births, Washington County saw more preterm births (28% vs. 21%) and slightly more low birthweights (24% vs. 22%). More Neonatal Intensive Care Unit (NICU) admissions (51% vs. 35%) and more Neonatal Abstinence Syndrome (NAS) diagnoses (54% vs. 36%) were observed in Allegheny vs. Washington Counties.

Conclusion: Although the population-adjusted incidence of pregnancies affected by HCV was higher in the rural county, we observed similar demographics and history of IDU. More individuals in the urban county received MOUD during pregnancy and ever received HCV treatment. Care uptake and pregnancy outcomes were similar, whereas NICU admission and NAS diagnosis were more common in the urban county. We continue to conduct infant follow-up to age 24-months. Analysis of infant follow-up outcomes will enhance care uptake and pregnancy outcomes information.