New Recommendations for Managing Hepatitis C Infection During Pregnancy

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Not enough is known about how HCV drugs can affect a woman during pregnancy or how the pregnancy affects the uptake, metabolism, or effectiveness of the drug.
Not enough is known about how HCV drugs can affect a woman during pregnancy or how the pregnancy affects the uptake, metabolism, or effectiveness of the drug.

The Society for Maternal-Fetal Medicine (SMFM) has released new clinical guidelines regarding the management of hepatitis C virus (HCV) infection during pregnancy. The recommendations will be published in the November issue of the American Journal of Obstetrics and Gynecology.

Specially, the SMFM recommends the following:

  • Women who may be at increased risk of HCV should be screened at the first prenatal visit. Risk factors include use of injected or intranasal illegal drugs, long-term hemodialysis, women who have received a tattoo or medical procedure in an unregulated setting; organ transplant or blood product recipients, history of incarceration, women seeking care for sexually transmitted infections (STIs), and chronic liver disease.

  • Screening should be repeated later in pregnancy for women with persistent or new risk factors.
  • HCV-positive pregnant women should be screened for other STIs and vaccinated for hepatitis A and B during pregnancy.
  • If invasive prenatal diagnostic testing is requested, women should be counseled that data on the risk of vertical transmission are limited; amniocentesis is preferred over chronic villus sampling.
  • HCV alone is not an indication for cesarean birth.
  • Avoid internal fetal monitoring, prolonged rupture of membranes, and episiotomy in HCV-positive women.
  • Treat HCV in the postparum period. Currently, direct-acting antiviral agents (DAAs) have not been approved for use in pregnant women. Ribavirin is contraindicated in pregnancy.
  • HCV-positive women can breastfeed.

With regard to treatment, Brenna Hughes, MD, MSc, lead author and SMFM member notes that not enough is known about how HCV drugs can affect a woman during pregnancy or how the pregnancy affects the uptake, metabolism, or effectiveness of the drugs.

"More research on HCV during pregnancy is needed to further our understanding of the virus and its treatment," said ACOG Vice President of Practice Activities, Christopher M. Zahn, MD. "With further information, obstetric care providers will be able to adequately screen for HCV and counsel pregnant women who are HCV-positive."

Reference

SMFM Consult Series #43, Hepatitis C in pregnancy: screening, treatment, and management. Society for Maternal and Fetal Medicine website. https://www.smfm.org/publications/248-smfm-consult-series-43-hepatitis-c-in-pregnancy-screening-treatment-and-management. Accessed October 31, 2017. 

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