Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing

Objective-To examine the value of universal antenatal screening for hepatit is C virus (HCV) infection among an inner London population, with regard to prevalence, uptake, and acceptability of testing, and identification of ne w cases. Design-Serum analysis for antibodies against HCV in pregnant women followin g informed consent ("opt out" policy). Samples positive for HCV antibodies were tested for the presence of HCV RNA by polymerase chain reaction. Infor mation on hepatitis C was provided for all women. Acceptability of antenata l HCV testing and identification of risk factors for infection were assesse d through the use of questionnaires randomly distributed among a cohort of 300 pregnant women. Setting-Antenatal clinics at St Mary's Hospital, London , serving a multiethnic population. Subjects-A total of 4825 pregnant women booking for antenatal care between November 1997 and April 1999. Results-The overall prevalence of anti-HCV was 0.8% and HCV viraemia was 0. 6%. Ninety eight per cent of samples (n=4729) were tested; 0.2% of women ha d a false positive result. In 207 women who completed a questionnaire regar ding our testing policy, 84% made a positive decision to be tested for anti -HCV and 92% said that HCV testing should be offered to all pregnant women. The majority (22/32-69%) of HCV infected women were newly diagnosed and al though HCV positive women were significantly more likely to have a history of drug abuse, most (16/22-73%) new cases had no identified risk factors fo r HCV infection at booking. Conclusion-The prevalence of anti-HCV in an inner London multiethnic antena tal population is high (0.8%). Routine screening for HCV is acceptable to p regnant women. The majority of women diagnosed during their current pregnan cy would not have been identified as HCV infected by epidemiological risk f actors at the time of booking.