Washington, D.C.—As the rate of hepatitis C infections continues to increase, including among pregnant individuals, the American College of Obstetricians and Gynecologists (ACOG) today released new guidance, “Viral Hepatitis in Pregnancy,” which includes critical information and recommendations on screening, treatment, management, and vaccination.
ACOG recommends routine, universal screening early in each pregnancy for hepatitis B and hepatitis C. Ideally, hepatitis C infection would be diagnosed before pregnancy. Therefore, when possible, prepregnancy hepatitis C screening is recommended in accordance with the recommendation for screening at least once in all adults.
“Hepatitis screening during pregnancy is an opportunity to promote a dialogue between pregnant patients and their clinicians about hepatitis transmission; ongoing and new risk factors; and, if not previously vaccinated, hepatitis B vaccination in pregnancy,” said Brenna Hughes, MD, MSc, FACOG, co-lead author of the guidance.
ACOG recommends that antivirals be used during pregnancy for patients with hepatitis B virus infection and viral load above a certain threshold to decrease the risk of passing the virus to the fetus. The clinical guidance provides detailed information about preventing neonatal transmission and states that cesarean delivery is not recommended solely for the purpose of decreasing transmission of hepatitis B and C.
Hepatitis C infection is treatable with direct-acting antivirals; however, this treatment is not yet approved during pregnancy, highlighting the importance of prepregnancy and postpartum therapy. Obstetrician–gynecologists are encouraged to connect pregnant patients who screen positive for hepatitis C infection during pregnancy with hepatitis care so they can begin direct-acting antiviral treatment postpartum and after the completion of lactation. Additionally, it is important to connect patients who test positive for hepatitis C before pregnancy to treatment so that they can complete direct-acting antiviral treatment before becoming pregnant.
“When it comes to management of the virus, it is critical for both hepatitis B and hepatitis C that we assess the stability of maternal disease and how likely it is to cause pregnancy complications,” said Denise Jamieson, MD, MPH, FACOG, co-lead author of the guidance. “A multidisciplinary approach with input from a hepatitis specialist, such as a gastroenterologist or infectious disease specialist, is recommended. Patients should be counseled to abstain from alcohol, and recommended vaccinations should be discussed.”
The guidance also includes a new recommendation regarding hepatitis B triple panel screening. ACOG recommends triple panel screening for all pregnant patients who do not have a documented negative triple screen after age 18 years; have not completed a hepatitis B vaccine series; or have ongoing known risks for hepatitis B infection, regardless of vaccination status or history of testing.
Hepatitis A, hepatitis B, and combined hepatitis A-B vaccines are considered safe in pregnancy. ACOG recommends vaccination for hepatitis A virus, hepatitis B virus, or both during pregnancy for recommended groups. Both hepatitis A and hepatitis B are vaccine-preventable infections, and hepatitis C infections can be cured.
“Hepatitis C is the most commonly reported blood-borne infection in the United States, especially among those of childbearing age,” Hughes said. “Obstetrician–gynecologists play an integral role in addressing the serious public health threat posed by viral hepatitis. If we successfully raise awareness among both clinicians and patients, there is no reason why we can’t reverse course.”
The Clinical Practice Guideline “Viral Hepatitis in Pregnancy” is being published in the September edition of Obstetrics & Gynecology.