P0335 - Low Breastfeeding Rates and Complex Barriers to Breastfeeding and Breast Milk Utilization in Hepatitis C Perinatally Exposed Infants

Background:
Rates of hepatitis C virus (HCV) infection have increased in recent years in the state of Kentucky (KY) parallel to the epidemic of opioid drug use. Pregnant women and women of childbearing age are disproportionately affected. HCV is present in breast milk, but maternal HCV infection is not a contraindication to breastfeed or breast milk utilization. The American Academy of Pediatrics (AAP) recommends breastfeeding, unless bleeding or cracked nipples are present. Despite these recommendations, there are misconceptions and barriers to breastfeed among HCV infected women. There are few studies demonstrating rates of breastfeeding or breast milk utilization in infants perinatally exposed to HCV. We sought to determine the rates of breastfeeding and potential barriers in a cohort of infants perinatally exposed to HCV in KY, an area of high incidence of HCV.

Methods:
We conducted a retrospective cohort study of infants perinatally exposed to HCV presenting to a pediatric infectious disease clinic from 2012 to 2018 in Louisville, KY. De-identified demographic and clinical information from the mother-infant dyads was abstracted from the medical record to a standardized form and recorded in a spreadsheet. The main outcome was documentation of breast milk or breastfeeding initiation at discharge from the birth hospital. Bivariant analysis with logistic regression was used to determine the association among studied variables

Results:
We collected data on 505 infants perinatally exposed to HCV. Infants with unknown feeding regimens and/or unknown/positive maternal HIV status were excluded, leaving 404 infants for final analysis. Of HCV exposed infants, 51% (n=206) were male, 86% (n=338) were white, 73% (n=275) were born in the metro area, and 66% (n=257) were full term. Breast milk utilization rate at discharge was 24.8%. Barriers to breastfeeding identified included: discharge to non-biological parent (48%, p<0.0001), admission to the neonatal intensive care unit (NICU) [18.2%; p<0.0001], and recreational drug use during pregnancy (17.1%; p = 0.001).

Conclusions:
Overall, our cohort of infants perinatally exposed to HCV have significantly low rates of breastfeeding or breast milk initiation at hospital discharge. Numerous factors act as barriers to breastfeeding, including NICU admission, discharge to non-biological parent, and maternal recreational drug use during pregnancy. This study indicates that more support is needed to improve breastfeeding rates and breast milk utilization in infants born to HCV positive mothers. Additional studies are granted as HCV is currently a public health concern.