From the Guidelines
Hepatitis C diagnosed during pregnancy requires careful management, and the recommended approach is to defer treatment until after delivery, as the safety of direct-acting antiviral (DAV) medications during pregnancy has not been established, although treatment can be considered during pregnancy on a case-by-case basis after a discussion of potential risks and benefits 1.
Implications of HCV Diagnosis During Pregnancy
The implications of a Hepatitis C (HCV) diagnosis during pregnancy are significant, and careful management is necessary to minimize risks to both the mother and the fetus.
- HCV infection may influence the outcome of pregnancy, leading to a higher incidence of preterm births, intrauterine fetal death, preterm delivery, and small-for-gestational age 1.
- Higher rates of antepartum and postpartum hemorrhage, gestational diabetes, or premature rupture of membranes have been reported in women with HCV infection 1.
- Chronic HCV infection has also been linked with higher rates of intrahepatic cholestasis of pregnancy 1.
Management of HCV During Pregnancy
During pregnancy, monitoring should include liver function tests each trimester and referral to a hepatologist or infectious disease specialist with experience in managing hepatitis C.
- Treatment with direct-acting antiviral (DAV) regimens such as sofosbuvir/velpatasvir (Epclusa) for 12 weeks or glecaprevir/pibrentasvir (Mavyret) for 8-12 weeks is typically effective after delivery, with cure rates exceeding 95% 1.
- Breastfeeding is considered safe for women with hepatitis C, as the virus is not transmitted through breast milk 1.
- The risk of mother-to-child transmission during pregnancy is approximately 5-6%, with higher rates in women who are co-infected with HIV or have high viral loads 1.
- There is no intervention during pregnancy that reduces transmission risk, and cesarean section is not recommended solely to prevent transmission 1.
Screening and Testing
- Universal screening during pregnancy is supported by the CDC and has been shown to be cost-effective 1.
- All infants born to mothers with hepatitis C should be tested for the virus at 18 months of age using antibody testing, or earlier with RNA testing if earlier diagnosis is desired 1.
From the Research
Implications of a Hepatitis C Diagnosis During Pregnancy
The implications of a Hepatitis C (HCV) diagnosis during pregnancy are significant and can have adverse effects on both the mother and the fetus. Some of the key implications include:
- Increased risk of adverse fetal outcomes, such as fetal growth restriction and low birth weight 2, 3
- Risk of mother-to-infant transmission of HCV, which can occur in utero or during the peripartum period 2, 3, 4
- Increased risk of poor perinatal outcomes for the children of women with HCV infection 4
Management and Treatment of HCV During Pregnancy
The management and treatment of HCV during pregnancy are crucial to prevent mother-to-infant transmission and reduce the risk of adverse fetal outcomes. Some of the key recommendations include:
- Screening for HCV infection at the first prenatal visit, with repeat screening later in pregnancy for women with persistent or new risk factors 2
- Counseling patients with HCV infection to abstain from alcohol 2
- Avoiding internal fetal monitoring, prolonged rupture of membranes, and episiotomy during labor in HCV-positive women 2
- Recommending against cesarean delivery solely for the indication of HCV 2, 5
- Allowing breastfeeding in women with HCV infection, as it has not been demonstrated to be a risk for mother-to-child transmission 2, 5, 4
Future Directions for HCV Treatment During Pregnancy
The treatment of HCV during pregnancy is an area of ongoing research, with new direct-acting antiviral agents showing promise in curing the disease. Some of the key future directions include: