From the Guidelines
Treatment of hepatitis C during pregnancy should be deferred until after delivery, unless in a clinical trial setting, due to limited safety data on direct-acting antivirals (DAAs) in pregnant women 1. The current approach to managing hepatitis C in pregnancy involves careful monitoring rather than immediate antiviral therapy. According to the Society for Maternal-Fetal Medicine, DAA regimens should only be initiated in the setting of a clinical trial during pregnancy, and people who become pregnant while taking a DAA should be counseled in a shared decision-making framework about the risks and benefits of continuation 1. Key aspects of care include:
- Screening all pregnant patients for HCV by testing for anti-HCV antibodies in every pregnancy, as recommended by the Society for Maternal-Fetal Medicine 1
- Vaccination against HAV and HBV (if not immune) for patients with HCV, to prevent coinfection and its complications 1
- Avoiding internal fetal monitors and early artificial rupture of membranes when managing labor in patients with HCV, unless necessary in the course of management 1
- Breastfeeding is considered safe for mothers with hepatitis C, as the virus is not transmitted through breast milk, unless nipples are cracked or bleeding 1 Referral to a hepatologist or infectious disease specialist during pregnancy for patients with HCV may be considered to expedite therapy after pregnancy. Postpartum treatment options can then be discussed, taking into account the viral genotype and presence of cirrhosis.
From the Research
Treatment of Hepatitis C in Pregnancy
- Hepatitis C virus (HCV) infection is a significant concern in pregnancy, with an estimated 1-2.5% of pregnant women in the United States infected with the virus 2, 3.
- The risk of mother-to-infant transmission of HCV is approximately 5-6% 2, 3.
- Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection, but it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight 3, 4.
Screening and Management
- The Society for Maternal-Fetal Medicine recommends screening 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.
- There are currently no approved treatment regimens for HCV in pregnancy, but universal screening and antepartum therapy may be considered in the future 5.
- The current preferred treatment for patients with HCV outside of pregnancy is combination therapy consisting of pegylated interferon alfa and ribavirin (RBV) for 24-48 weeks 6.
Delivery and Breastfeeding
- Altering the mode of delivery does not reduce mother-to-child transmission of HCV, and cesarean delivery should not be performed solely for the indication of HCV 2, 4.
- Breastfeeding has not been demonstrated to be a risk for mother-to-child transmission, and avoidance of breastfeeding is not recommended 2, 4.