Hepatitis C is a growing threat to moms and babies. But screening is inadequate.

By Christine Nguyen
January 29, 2022 at 9:00 a.m. EST  THE WASHINGTON POST

During her third pregnancy, Jamie Smith was itchy. Crazy itchy. Her obstetrician diagnosed her with cholestasis of pregnancy, a serious complication associated with liver disease. Her baby was at risk for being premature or even stillborn, so she was induced at 38 weeks.
Smith’s baby was healthy, but her own problems continued. She had muscle pain, brain fog and icy white hands and feet. Maybe at age 39, she figured, she was just getting older. Her new primary care doctor suggested some tests, including for hepatitis C. It was just a precaution. Her obstetrician had said her liver enzymes were normal and the regular screening tests were negative. While walking her dog near her home in Ohio, Smith casually scanned the electronic results on her phone.
“It said, ‘positive,’ ” she recalled, “And I’m like, ‘I don’t even know what hep C means.’ Wait, positive is a bad thing, right?”
At home, she searched “What is hep C?” online, which sent her down an Internet rabbit hole of common risk factors, including IV drug use, tattoos or piercings, having HIV or spending time in prison. She cried.
“I have lived the most boring life,” Smith said. “So it was a shock that I had this virus that comes with this stigma.”
Only later did her doctor connect the hepatitis C diagnosis to lifesaving blood transfusions she received in 1981, when she was a premature baby. Smith had lived with hepatitis C her entire life and exposed each of her three children. Women with hepatitis C have a higher risk of cholestasis of pregnancy, the liver problem that caused her severe itching.
Hepatitis C is the leading blood-borne disease in the United States, affecting at least an estimated 2.5 million Americans. Half of them don’t know they have it. The disease used to occur mostly among baby boomers. After World War II, a combination of increased medical procedures and recreational drug use drove the spread of the disease before widespread screening was available in the 1990s. But now people ages 20 to 39 are most likely to get infected, according to the Centers for Disease Control and Prevention, a shift experts attribute to the opioid crisis and needle-sharing. The CDC says adults with hepatitis C are at higher risk for severe illness from covid-19.

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