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Background The epidemic of drug abuse has led to increased incidence of hepatitis C virus (HCV) infection in young adults, including women of childbearing age. Infected pregnant women can transmit HCV vertically to their infants, and exposed infants require close follow-up. Few studies focus on illicit drug use during pregnancy in HCV positive mothers. We sought to describe rates of illicit drug use during pregnancy in a convenience cohort of infants perinatally exposed to HCV in an area with high rates of HCV and illicit drug use. Methods Infants born to HCV positive mothers in the Louisville, KY metro area and surrounding hospitals were followed at a pediatric infectious disease clinic after institution of a clinical protocol. Records of exposed infants attending the clinic between 2012 and 2018 were analyzed retrospectively. Cases were identified using V01.79 (ICD9) and Z20.5 (ICD10) billing codes. Maternal information was extracted from the infant electronic medical record or the maternal record if available. Demographic and clinical information was collected using a standardized instrument. Descriptive statistics described the data and logistic regression was used to assess associations. Results A total of 505 infants attended the clinic for evaluation of perinatal exposure to HCV. Records with no information regarding maternal drug use during pregnancy were excluded, leaving 440 for analysis. Mean maternal age was 28 years (IQR 25-31), and parity 2 (IQR 1-3). The majority of mothers (89.0%, N=380) had a history of any illicit drug use and 81.1% (N=355) had a history of intravenous drug use (IVDU). Most (63.2%, N=278) reported continued illicit drug use during pregnancy. The most common drugs used during pregnancy were heroin (45.4%), THC (22.9%), and amphetamines (25.4%). Prenatal care was associated with less maternal illicit drug use during pregnancy (aOR, 0.33; p &amp;lt; 0.0001). Conclusion HCV positive pregnant women have high rates of prior and continued use of illicit and IVDU during pregnancy. Pregnancy represents a unique opportunity to link HCV infected women to care. Public health programs supporting these women and elimination of state restrictions to treat this population will prevent future exposures. Additional qualitative studies to identify needs for this population are needed. Disclosures Claudia M. Espinosa, MD, MSc, AstraZeneca (Speaker’s Bureau)Gilead (Grant/Research Support)Kentucky Rural Association (Consultant)Merck (Grant/Research Support)Sanofi (Consultant)

1056. At the Intersection of Drug Use, Motherhood, and Hepatitis C: An Evaluation of Our Present State