# Seroprevalence and Determinants of Hepatitis B Virus and Hepatitis C Virus Infection Among Pregnant Women in North India: A Cross-Sectional Study

## TL;DR

This study finds that about 3% of pregnant women in North India have hepatitis B or C, with risk factors like unsafe injections and family history, and highlights the need for better screening and neonatal protection.

## Contribution

The study provides updated seroprevalence data and identifies specific risk factors for HBV and HCV among pregnant women in Lucknow, North India.

## Key findings

- The overall prevalence of viral hepatitis among pregnant women was 2.8%, with 2.5% HBsAg and 0.3% anti-HCV positivity.
- Independent predictors included family history of hepatitis, unsafe injections, and sharing sharp instruments.
- Neonatal immunoprophylaxis adherence was documented to assess vertical transmission prevention efforts.

## Abstract

Background

Maternal hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain major contributors to perinatal and early childhood hepatitis transmission in India. Despite national guidelines recommending universal antenatal screening, coverage gaps persist. This study aimed to determine the prevalence, associated risk factors, and preventive outcomes of HBV and HCV among pregnant women in Lucknow District, North India.

Objectives

The primary objectives of this cross-sectional study were to determine the prevalence of HBV and HCV among pregnant women attending antenatal clinics (ANCs) at primary and secondary health facilities in Lucknow; to assess the risk factors associated with HBV and HCV infection among pregnant women; and to study pregnancy outcomes among HBV/HCV-positive pregnant women. Additionally, we documented whether neonates born to HBV-positive mothers received standard immunoprophylaxis, including hepatitis B immunoglobulin (HBIG) and the hepatitis B birth-dose vaccine.

Methods

A hospital-based cross-sectional study was conducted among 2005 pregnant women attending ANCs. Serum samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using rapid diagnostic kits at the health facilities, followed by viral load assessment at the Model Treatment Centre (MTC). Sociodemographic, obstetric, and exposure-related data were analyzed using univariate and multivariate logistic regression to identify independent predictors. The timely administration of the hepatitis B birth-dose vaccine and HBIG to neonates born to hepatitis-positive mothers, in accordance with established national protocols, was also documented.

Results

The overall prevalence of viral hepatitis among pregnant women was 2.8%, including 2.5% HBsAg positivity and 0.3% anti-HCV positivity, with no observed co-infection. Prevalence was significantly higher among women aged ≥25 years. Independent predictors of infection included a sibling history of hepatitis (adjusted odds ratio (AOR) 11.68, p=0.001), unsafe injections administered by unqualified practitioners (AOR 5.07, p=0.024), sharing of sharp instruments such as blades or razors (AOR 5.58, p=0.018), a history of jaundice or prior HBsAg positivity (AOR 5.93, p=0.021), and a family member receiving treatment for HBV or HCV (AOR 15.36, p=0.003). Maternal clinical parameters were reviewed to facilitate appropriate referral and follow-up care in accordance with ethical guidelines.

Conclusion

This study underscores the importance of universal antenatal screening and regulation of unsafe injection practices. The implementation of comprehensive maternal screening in conjunction with timely neonatal immunoprophylaxis may contribute to reducing vertical transmission and aligns with India’s commitment to the World Health Organization’s 2030 hepatitis elimination agenda.