What are the implications of Hepatitis C (HCV) on pregnancy?

From the Guidelines

Pregnant women with hepatitis C should be screened during pregnancy, but treatment is typically postponed until after delivery. The standard hepatitis C treatments (direct-acting antivirals like sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) are not recommended during pregnancy due to insufficient safety data 1.

Key Considerations

• The risk of mother-to-child transmission is relatively low at approximately 5% 1, with higher rates in women who are co-infected with HIV or have high viral loads.
• Cesarean section is not routinely recommended solely to prevent transmission, as the mode of delivery doesn't significantly impact transmission rates 1.
• Breastfeeding is generally considered safe for mothers with hepatitis C unless nipples are cracked or bleeding 1.
• After delivery, mothers can be treated with standard hepatitis C regimens, which typically involve 8-12 weeks of direct-acting antivirals with cure rates exceeding 95% 1.
• Babies born to mothers with hepatitis C should be tested for the virus at 18 months of age when maternal antibodies have cleared.

Management Recommendations

• Obstetrical providers should screen all pregnant patients for hepatitis C virus by testing for anti-hepatitis C virus antibodies in every pregnancy 1.
• Vaccination against hepatitis A and B viruses (if not immune) is recommended for patients with hepatitis C virus 1.
• Direct-acting antiviral regimens should only be initiated in the setting of a clinical trial during pregnancy 1.
• Cesarean delivery solely for the indication of hepatitis C virus is not recommended 1.
• Internal fetal monitors and early artificial rupture of membranes should be avoided when managing labor in patients with hepatitis C virus unless necessary 1.

From the Research

Hepatitis C in Pregnancy

• Hepatitis C virus (HCV) infection is a significant concern during 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 can 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.

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.
• Women with HCV infection should be counseled to abstain from alcohol and screened for other sexually transmitted diseases, including HIV, syphilis, gonorrhea, chlamydia, and hepatitis B virus 2.
• Direct-acting antiviral regimens are not currently approved for use in pregnancy, and treatment should be deferred to the postpartum period 2, 3.

Treatment and Prevention

• There are currently no approved treatment regimens for HCV in pregnancy, but recent studies have focused on the safety and efficacy of direct-acting antiviral initiation during pregnancy 4.
• Breastfeeding is not contraindicated in women with HCV infection, and providers should not discourage breastfeeding based on a positive HCV status 2.
• Effective treatment of HCV infection in women diagnosed during pregnancy can prevent HCV-related adverse events in pregnancy and vertical transmission in future pregnancies 5.

Linkage to Care

• Linkage to care and treatment for women diagnosed with HCV in pregnancy remains insufficient, and there is a need for best practice recommendations to ensure appropriate peripartum linkage to HCV care and treatment 5.
• A Community of Practice has been established to provide a series of best practices to improve linkage to HCV treatment for pregnant and postpartum women, including specific interventions to enhance colocation of services, treatment by non-specialist providers, and active engagement and patient navigation 5.