Hepatitis C in Pregnancy: Review of Current Knowledge and Updated Recommendations for Management

Importance An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which carries approximately a 6% risk of mother-to-infant transmission. Objectives The aims of this article are to review the current evidence on HCV in pregnancy and to provide updated recommendations for management. Evidence Acquisition Original research articles, review articles, and guidelines on HCV in general and specifically in pregnancy were reviewed, as were drug safety profiles from the Food and Drug Administration. Results Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection. However, it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight, and can be transmitted to the infant in utero or during the peripartum period. No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk. To date, no treatment regimens for HCV have been approved for use in pregnancy, but the new ribavirin-free, direct-acting antiviral regimens are being used with high efficacy outside pregnancy. Conclusions and Relevance Hepatitis C virus infection in pregnancy generally does not adversely affect maternal well-being but is associated with adverse effects on the fetus because of pregnancy complications and vertical transmission. There are currently no approved treatment regimens for HCV in pregnancy; this should be an active area of research in obstetrics. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completion of this educational activity, the obstetrician/gynecologist should be able to summarize current knowledge on the impact of pregnancy on maternal chronic hepatitis C, identify risks that maternal hepatitis C infection presents to the fetus, discuss the evidence on perinatal interventions and the risk of vertical transmission of HCV, and outline how to screen for, diagnose, and provide appropriate prenatal care for hepatitis C in pregnancy.