(Reaffirmed October 2022)
This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with Brenna L. Hughes, MD, MSc; Denise J. Jamieson, MD, MPH; Anjali J. Kaimal, MD, MAS; Aaron B. Caughey, MD, PhD; Ahizechukwu Eke, MD, PhD, MPH; and Megan McReynolds.
The Society for Maternal-Fetal Medicine endorses this Practice Advisory.
Hepatitis C is the most commonly reported bloodborne infection in the United States 1 , with an estimated 50,300 new hepatitis C virus (HCV) infections in the United States in 2018. Over 65% of acute HCV cases reported to the Centers for Disease Control and Prevention (CDC) in 2018 were among persons aged 20–39 years 1 . Due to the increasing number of HCV infections among women of childbearing age, perinatal transmission (intrauterine and intrapartum) is increasing. In 2015, 0.38% of live births were delivered by women with hepatitis C infection 2 . Approximately 6% of infants born to women with hepatitis C will become infected 3 .
In the setting of increasing hepatitis C infections and the development of effective treatments, public health organizations have recommended increased hepatitis C screening. The United States Preventive Services Task Force recommends that each adult be screened once in their lifetime 4 . Because of the increase in infections in women of reproductive age and the implications for perinatal transmission, the CDC has revised their HCV screening recommendations to include screening for pregnant individuals during each pregnancy in addition to screening for all adults at least once in their lifetime 5 . The American College of Obstetricians and Gynecologists is updating its hepatitis C screening guidance to recommend screening for all pregnant individuals during each pregnancy. Hepatitis C screening during the first prenatal blood assessment obtained in every pregnancy is recommended to identify pregnant individuals with HCV infection and infants who should receive testing at a pediatric visit. Hepatitis C screening during pregnancy should be an opportunity to promote a dialogue between pregnant individuals and their clinician about hepatitis C transmission and risk factors.
There is currently no HCV treatment approved for use during pregnancy. Obstetrician-gynecologists are encouraged to connect pregnant patients who screen positive for HCV during pregnancy with hepatitis care so that these individuals may begin direct-acting antiviral treatment postpartum and after completion of breastfeeding. Systems should be in place to inform the pediatrician responsible for the care of the newborn about the mother’s hepatitis C carrier status.
Ideally, HCV infection would be diagnosed before pregnancy, and, when possible, pre-pregnancy screening for HCV is recommended in individuals who have not yet been screened, in accordance with the recommendation for screening at least once in all adults 4 5 . When patients test positive for HCV before pregnancy, obstetrician-gynecologists should connect them with care so that they can complete direct-acting antiviral treatment before becoming pregnant.