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Screening and Treatment of HCV in Pregnancy

Am J Obstet Gynecol; ePub 2017 Aug 3; Hughes, et al

The Society for Maternal-Fetal Medicine (SMFM) has issued recommendations for the screening, treatment, and management of hepatitis C virus (HCV) during pregnancy, which is associated with increased risk of adverse fetal outcomes, including fetal growth restriction and low birth rate. The SMFM recommends:

  • Obstetric care providers should screen women who are at increased risk for HCV by testing for anti-HCV antibodies at their first prenatal visit. If initial results are negative, HCV screening should be repeated later in pregnancy in women with persistent or new risk factors for HCV infection after their initial screening.
  • Obstetric care providers should screen HCV-positive pregnant women for other sexually transmitted diseases, including human immunodeficiency virus (HIV), syphilis, gonorrhea, chlamydia, and hepatitis B virus (HBV).
  • Patients with HCV, including pregnant women, should be counseled to abstain from alcohol.
  • Direct-acting antiviral medications (DAA) regimens should only be used in the setting of a clinical trial or antiviral treatment should be deferred to the postpartum period as DAA regimens are not currently approved for use in pregnancy.
  • If invasive prenatal diagnostic testing is requested, women should be counseled that data on the risk of vertical transmission is reassuring but limited; amniocentesis is recommended over chorionic villus sampling given the lack of data on the latter.
  • Cesarean delivery is not recommended solely for the indication of HCV.
  • Obstetric care providers should avoid internal fetal monitoring, prolonged rupture of membranes, and episiotomy in managing labor in HCV-positive women.
  • Discouraging breastfeeding based on a positive HCV infection status is not recommended.

Citation:

Hughes BL, Page CM, Kuller JA. Society for Maternal-Fetal Medicine (SMFM) Consult Series #43: Hepatitis C in Pregnancy: Screening, treatment, and management. [Published online ahead of print August 3, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.07.039.