Hepatitis C in Pregnancy

Contributor: Dr Kacey Eichelberger 
Last Update: 4/10/18  

Quick Facts

• 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:

1. Injectable illicit drug use (ever)
2. Current user of intranasal illicit drugs
3. Hemodialysis use (ever)
4. Incarceration (ever)
5. Tattoos from unlicensed parlors
6. Organ transplant pre 1982, OR history of receiving clotting factor concentrate pre 1987
7. 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.

1. 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.
2. 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.
3. 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.
4. We recommend repeat HCV RNA testing in the third trimester for these patients.

 

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Reference

• Hepatitis C in pregnancy: screening, treatment, and management. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, 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.