From the Guidelines
All pregnant women should be screened for Hepatitis C virus (HCV) at their first prenatal visit, as it is a crucial step in managing the infection and preventing mother-to-child transmission. The risk of HCV transmission from mother to child is approximately 5-6%, with higher rates in women who are co-infected with HIV or have high viral loads 1.
Implications of HCV Infection in Pregnancy
HCV infection during pregnancy can lead to adverse fetal outcomes, including fetal growth restriction and low birthweight 1. Additionally, HCV-positive women are at a higher risk of preterm births, intrauterine fetal death, and small-for-gestational age babies 1.
Management of HCV Infection in Pregnancy
Direct-acting antiviral (DAA) therapy is typically postponed until after delivery, as these medications are not yet fully approved for use during pregnancy 1. However, in some cases, DAA therapy may be considered during pregnancy on a case-by-case basis, after a thorough discussion with the patient about the potential risks and benefits 1.
Breastfeeding and HCV Transmission
Breastfeeding is generally considered safe for HCV-positive mothers unless nipples are cracked or bleeding, as the risk of HCV transmission through breast milk is low 1.
Testing and Follow-up
Infants born to HCV-positive mothers should be tested for HCV RNA at 2-3 months of age and for HCV antibodies after 18 months of age when maternal antibodies have cleared 1. Once the mother has completed breastfeeding, she should be referred for HCV treatment with appropriate DAA regimens, which typically achieve cure rates exceeding 95% with 8-12 weeks of therapy 1.
Key Recommendations
- Screen all pregnant women for HCV at their first prenatal visit 1
- Postpone DAA therapy until after delivery, unless considered on a case-by-case basis 1
- Breastfeeding is safe for HCV-positive mothers unless nipples are cracked or bleeding 1
- Test infants born to HCV-positive mothers for HCV RNA and antibodies at recommended ages 1
From the Research
Implications of Hepatitis C Infection in Pregnancy
- Hepatitis C virus (HCV) infection in pregnancy carries an approximately 5% risk of transmission from mother to infant 2.
- Infection during pregnancy is associated with increased risk of adverse fetal outcomes, including fetal growth restriction and low birthweight 2, 3.
- HCV can be transmitted to the infant in utero or during the peripartum period 2, 3.
Screening and Management
- Obstetric care providers should screen women who are at increased risk for HCV infection by testing for anti-HCV antibodies at their first prenatal visit 2.
- HCV-positive pregnant women should be screened for other sexually transmitted diseases, including HIV, syphilis, gonorrhea, chlamydia, and hepatitis B virus 2.
- Patients with HCV, including pregnant women, should be counseled to abstain from alcohol 2.
Treatment
- Direct-acting antiviral regimens are not currently approved for use in pregnancy, and treatment should be deferred to the postpartum period 2, 4, 3.
- However, some studies suggest that directly acting antivirals (DAAs) may be considered in the late 2nd and early 3rd trimester, but more research is needed to determine their safety and efficacy in pregnancy 4.
Prevention of Vertical Transmission
- No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk 3.
- Cesarean delivery is not currently recommended for the sole purpose of reducing vertical transmission risk in pregnant women with HCV 2, 5.
- Breastfeeding is recommended in women with HCV, as the risk of transmission through breast milk is considered low 2, 5.