Screening for Hepatitis C During Pregnancy at a Toronto Inner City Prenatal Clinic
Screening for Hepatitis C During Pregnancy at a Toronto Inner City Prenatal Clinic
The first part of this study will investigate the incidence of Hepatitis C in pregnant women
 attending an inner city health clinic in downtown Toronto. All women attending the clinic who
 give their consent to participate will be screened by a standardized questionnaire as well as
 by a blood test. Blood testing will tell us how many of these women have Hepatitis C. We will
 then be able to compare the specificities and sensitivities of targeted screening (risk
 behaviour questionnaires) versus universal screening (blood tests).

 In the second part of the study we will follow the pregnancies of those women who were
 identified as Hepatitis C positive on the screening test. Follow- up will include liver
 enzymes and viral load quantifications (amounts) in the first, second and third trimesters as
 well as during delivery and six weeks post-partum. We will also document pregnancy outcomes
 with regard to type of delivery and complications. Pregnancy outcomes will be compared to an
 age and race matched group of women who do not have Hepatitis C.

 Study Hypothesis:

 We expect a higher incidence of Hepatitis C in this inner city population compared to the
 general Canadian pregnant population (0.9%). We predict an HCV seroprevalence (rate) ranging
 between 2-6% in this population and we also predict that targeted screening by standardized
 questionnaire will fail to identify half of the Hepatitis C positive cases.

 By following this group of Hepatitis C positive women through pregnancy, we expect to lend
 further support to previous data showing significant decrease and/or normalization of serum
 transaminases as well as significant increase in HCV viral load by third trimester. We also
 expect to see no significant differences in pregnancy outcomes or obstetrical complications
 between HCV positive women and the HCV negative women.
All women attending our prenatal clinic will be invited to participate in this research
 study. Participants will complete two short questionnaires during their first visit to our
 prenatal clinic and be tested for Hepatitis C. Women who test positive for Hepatitis C will
 be carefully followed during their pregnancies and will have viral load tests and liver
 function tests during each trimester, at delivery and six weeks after their babies are born.
 All women testing positive for Hepatitis C will be referred to a hepatologist (a liver
 specialist) after delivery and their babies will be referred to a pediatrician for further
 follow-up and care. Based on previous studies we are concerned that some women may never know
 that they are carriers unless their blood is checked for the virus. Currently testing for
 Hepatitis C during pregnancy is not routinely done.

 The results of this study will help us to find out how many women attending our prenatal
 clinic test positive for Hepatitis C and how many cases would have been missed if we only
 relied on one of the questionnaires to decide whether to do the blood test or not. (The
 questionnaire deals with factors that could put a person at risk for acquiring Hepatitis C).
 By following our Hepatitis C positive pregnant patients throughout their pregnancies,
 deliveries and after their babies are born we will learn more about how the virus changes
 during pregnancy. The type of deliveries, any complications and the overall state of health
 of the Hepatitis C positive mothers participating in this study will be reported. We will
 also be able to report on the number of babies who are born with the virus and the state of
 their health up to six months of age.
Inclusion Criteria:

 -  Females are 16 years of age and over who present to the inner city health clinic for
 antenatal care who give their informed consent to participate in this study.

 -  Participants read and understand English or assisted by an interpreter / family member
 enabling fully informed consent and participation in this study

 Exclusion Criteria:

 -  Females under the age of 16.

 -  Participants who do not read and understand English for whom no interpreters are
 available.