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Routine Hepatitis C Virus Screening in Pregnant Individuals

  • Practice Advisory PA
  • May 2021

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.


Please contact clinical@acog.org with any questions.

References

  1. Centers for Disease Control and Prevention. Viral hepatitis surveillance, United States, 2018. Atlanta, GA: CDC; 2020. Available at: https://www.cdc.gov/hepatitis/statistics/2018surveillance/pdfs/2018HepSurveillanceRpt.pdf. Retrieved April 5, 2021.
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  2. Schillie SF, Canary L, Koneru K, Nelson NP, Tanico W, Kaufman HW, et al. Hepatitis C virus in women of childbearing age, pregnant women, and children. Am J Prev Med 2018;55:633-41.
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  3. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis 2014;59:765-73.
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  4. Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana C, Caughey AB, et al. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. US Preventive Services Task Force [published online March 2, 2020]. JAMA. doi: 10.1001/jama.2020.1123
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  5. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults - United States, 2020. MMWR Recomm Rep 2020;69(RR-2):1-17.
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A Practice Advisory is a brief, focused statement issued to communicate a change in ACOG guidance or information on an emergent clinical issue (eg, clinical study, scientific report, draft regulation). A Practice Advisory constitutes ACOG clinical guidance and is issued only on-line for Fellows but may also be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.

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The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. www.acog.org