Test for Hepatitis C During Every Pregnancy

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UPDATED RECOMMENDATION:

The Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force recommend that prenatal care providers test all pregnant patients for hepatitis C during each pregnancy.

Female Family Doctor is Talking with Young Pregnant Patient During Consultation in a Health Clinic.

As of April 2020, the Centers for Disease Control and Prevention (CDC) recommends that prenatal care providers screen all pregnant persons for hepatitis C, a liver infection caused by the hepatitis C virus (HCV). Chronic HCV infection does not cause symptoms in most people but can lead to cirrhosis and liver cancer. Several studies have linked maternal HCV infection with worse pregnancy outcomes.  Hepatitis C can be transmitted from a mother to her baby. Identifying hepatitis C in pregnant people allows them to access treatment and identifies at-risk infants in need of testing and ongoing monitoring, as needed.

Why Test All Your Pregnant Patients?

  • New cases of hepatitis C are on the rise among reproductive aged adults. Rates of new HCV infections increased by more than 60% from 2015 to 2019. And in 2019, more than 63% of new HCV infections occurred among adults 20-39 years of age.
  • CDC expects rates of perinatal hepatitis C to increase. Rates of HCV infection nearly doubled during 2009–2014 among people with live births. From 2011-2014, an estimated 29,000 HCV-infected patients gave birth each year. HCV can be transmitted from an infected mother to the child during both pregnancy and childbirth.[i] HCV-infected mothers transmit their infection to their baby in 5.8% of pregnancies; the risk of transmission is higher if the mother is co-infected with HIV. As capacity for viral hepatitis surveillance improves, CDC anticipates that the number of perinatal hepatitis C cases identified and reported to CDC will increase.
  • Hepatitis C can lead to serious liver disease. More than half of new hepatitis C infections progress to chronic HCV infection. Without treatment, approximately 15-20% of people living with chronic HCV infection will develop progressive liver fibrosis and cirrhosis.
  • Hepatitis C can be cured. Over 90 percent of people infected with HCV can be cured with 8-12 weeks of oral therapy. [ii] Hepatitis C curative treatment is not currently approved for use during pregnancy; however, once the mother has given birth and completed breastfeeding, it is safe to begin this treatment. Furthermore, treatment is approved for children beginning at 3 years of age.
  • Your patients aren’t aware of their risk. Almost half of people with hepatitis C are unaware of their infection. Testing is the first step to accessing curative treatment.
  • Testing can connect mother and baby to care. All pregnant persons should be tested for hepatitis C during each pregnancy; screening during pregnancy can identify future care needs for both mother and baby.

What are CDC’s Hepatitis C Screening Recommendations?

All pregnant people should be screened for hepatitis C during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%. [iii]

Hepatitis C testing is usually initiated with an HCV antibody test which, if positive, indicates a history of past or present HCV infection. Any pregnant person testing positive for antibodies to HCV should receive a PCR test for HCV RNA to determine current infection status. Children born to HCV-infected mothers should be tested for HCV; HCV RNA testing can occur as early as 2 months of age, whereas testing for HCV antibodies (anti-HCV) should not occur before 18 months of age because antibodies to HCV from the mother might last until this age.

What Should I do if a Pregnant Patient Tests Positive for Hepatitis C Virus?

  • Test: The initial evaluation of persons diagnosed with HCV during pregnancy is generally similar to that of nonpregnant persons diagnosed with HCV and should include an HCV RNA level and a liver enzymes test. Pregnant persons with newly diagnosed HCV infection and abnormal serum aminotransferase and/or platelet levels should be promptly referred for further medical assessment to rule out liver fibrosis or injury and so antiviral treatment can be initiated at the appropriate time.
  • Report: Providers should report HCV infection in a pregnant person to infant’s health care provider so that follow-up HCV testing can be conducted at the recommended time, and to the local health department so that ongoing risk factors can be assessed and relevant contacts can receive hepatitis A and hepatitis B testing and vaccination, as indicated, and can be linked, as appropriate, to preventive services.

Additional Resources

Notes

[i] Breastfeeding is not considered a route of transmission if nipples are not cracked and bleeding.

[ii] While there are currently no treatments approved for use in pregnancy to prevent transmission of HCV to infants, screening during pregnancy can connect both mother and infant to care.

[iii] See CDC’s hepatitis C testing guidelines for detailed information on calculating prevalence in a health-care setting.