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To quantify the rising prevalence of maternal hepatitis C virus (HCV) infection in Ohio during the peak of the opioid epidemic and to identify maternal characteristics and obstetric outcomes associated with maternal HCV infection.We conducted a population-based retrospective cohort study of all live births in Ohio (2006–2015). Frequency of maternal HCV infection as reported on birth certificates was compared across each year of the study period. Maternal, obstetric, and neonatal characteristics were compared between women with HCV infection in pregnancy with those without HCV infection. Multivariate logistic regression estimated the relative association between HCV infection and various maternal characteristics and obstetric outcomes.During the 10-year study period, there were 7,069 reported cases of maternal HCV infection at the time of delivery among 1,463,506 (0.5%) live births in Ohio. The rate of maternal HCV infection increased 631% between 2006 and 2015, from 1.6 to 11.7 cases per 1,000 live births (relative risk [RR] 7.6, CI 6.6–8.7, P<.001). After adjusting for various confounders, demographic characteristics associated with HCV infection included cigarette smoking (adjusted RR 8.6, CI 8.0–9.1), Medicaid insurance (adjusted RR 3.6, CI 3.3–3.8), and white, non-Hispanic race (adjusted RR 3.2, 95% CI 2.9–3.5). Coinfection during pregnancy with hepatitis B, gonorrhea, chlamydia, syphilis, and herpes simplex virus infection was also associated with maternal HCV infection. Obstetric and neonatal outcomes associated with maternal HCV infection included cesarean delivery, fetal intolerance of labor, preterm birth, maternal intensive care unit admission, blood transfusion, small for gestational age (less than the 10th percentile), neonatal intensive care unit admission, need for assisted neonatal ventilation, and infant death.Maternal HCV infection has increased more than sevenfold over the past decade in Ohio. Our findings highlight a dramatic rise in maternal HCV infection that parallels the opioid epidemic within Ohio and in neighboring Appalachian states.