What are the recommendations for the treatment of pregnant women with hepatitis C virus (HCV) infection?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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The following recommendations are based on HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C, guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (ISDA). [9] They are subject to change.

All pregnant women should be tested for infection with hepatitis C virus (HCV), preferably at the start of prenatal care.

For risk reduction of HCV transmission to future offspring, women of reproductive age with confirmed HCV infection should receive antiviral therapy prior to pregnancy consideration when possible. There is no currently known intervention to reduce maternofetal transmission in pregnant women with HCV infection.

At the initiation of prenatal care, HCV-antibody-positive pregnant women should undergo HCV RNA and routine hepatic function studies to evaluate the risk of maternofetal transmission and severity of liver disease. These women should also receive prenatal and intrapartum care that is appropriate for their individual obstetric risk(s).

Clinicians should have a high index of suspicion for intrahepatic cholestasis or pregnancy in gravida with HCV and pruritus or jaundice, and evaluate these women with measurements of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and serum bile acids.

Counsel HCV-infected women with cirrhosis about the higher risk of adverse maternal and perinatal outcomes. In addition, coordinate antenatal and perinatal care with a maternal-fetal medicine obstetrician.

Postpartum, HCV- or HIV-HCV–infected mothers may breastfeed, unless she has cracked, damaged, or bleeding nipples. In addition, postdelivery HCV-infected women should be reevaluated for spontaneous clearance of their HCV RNA.

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