Contributor: Dr Kacey Eichelberger
Last Update: 4/10/18
- US prevalence estimates for pregnant women: 1-2.5%
- Risk of maternal to child transmission: 5%
- Modes of transmission: percutaneous exposure to blood from injection of illicit drugs (primary route in the US); maternal to child transmission; exposure to blood via occupational exposure; sexual intercourse (inefficient transmission route).
Who should be screened at intake prenatal visit? 1,2
- Women with unexplained elevated ALT or chronic liver disease
- Women seeking evaluation or care of STIs
- Women with a HISTORY of any of the following:
- Injectable illicit drug use (ever)
- Current user of intranasal illicit drugs
- Hemodialysis use (ever)
- Incarceration (ever)
- Tattoos from unlicensed parlors
- Organ transplant pre 1982, OR history of receiving clotting factor concentrate pre 1987
- Blood transfusion from HCV positive donor
Interpreting HCV serologies
HCV Antibody Non-reactive → No history of infection with HCV
HCV Antibody Reactive → Order HCV RNA → RNA detected → Current HCV infection 3
RNA not detected→ Cleared previous infection versus false positive antibody result 4
Obstetric Management of HCV in pregnancy
- Obtain baseline labs (HCV genotype, quantitative HCV RNA, AST, ALT, albumin, PT, platelet count, and bilirubin).
- Refer all patients with a diagnosis of HCV to a hepatologist, infectious disease specialist, or primary care doctor with expertise in management of hepatitis
- Reserve amniocentesis, fetal scalp electrodes, prolonged rupture of membranes, episiotomy, and operative vaginal delivery for carefully selected patients.
- Reserve cesarean delivery for standard obstetric indications.
- Breastfeeding permitted
- Notify pediatric provider of patient’s Hepatitis C status at delivery
- Ensure postnatal referral of the patient for management.
Other Considerations in Management of HCV
- Recommend that patients abstain from all alcohol
- Recommend total daily acetaminophen dose not to exceed 2 grams
- Routine serial lab surveillance not indicated
- No antiviral therapies are currently recommended for HCV infection in pregnancy. Recommend DAA (direct acting antiviral) regimens only on clinical trial protocols at this time.
- Patients in the GHS ObGyn Center are currently receiving universal screening for Hepatitis C (HCV) at the intake prenatal visit as part of an ongoing quality improvement investigation.
- Patients with continuing, ongoing risk factors for HCV transmission during pregnancy (new STI exposures, continued injectable illicit drug use) should be retested later in pregnancy.
- Any GHS patient with confirmed HCV infection in pregnancy may be referred to Allison Moore via Epic for invitation to participate in the NICHD’s Hepatitis C in Pregnancy observational trial.
- We recommend repeat HCV RNA testing in the third trimester for these patients.
- Hepatitis C in pregnancy: screening, treatment, and management. Society for Maternal-Fetal Medicine (SMFM). Electronic address: email@example.com, Hughes BL, Page CM, Kuller JA. Am J Obstet Gynecol. 2017 Nov;217(5):B2-B12. doi: 10.1016/j.ajog.2017.07.039. Epub 2017 Aug 4.