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Universal pregnancy screening for HCV could eliminate transmission in Canada

In a recently published commentary, Chelsea Elwood, MD, from the University of British Columbia, and colleagues advised that Canadian guidelines should recommend universal screening for hepatitis C in pregnant women as they do for hepatitis B and HIV to reduce the risk for vertical transmission.

“More years of life are lost because of HCV than any other infectious disease in Canada,” they wrote. “Hepatitis C virus infection does not appear to worsen maternal health; however, rates of preterm birth, low birth weight, obstetrical cholestasis and adverse neonatal outcomes, such as admission to a neonatal intensive care unit, are increased for pregnancies complicated by HCV infection.”

According to Elwood and colleagues, the seroprevalence rate of HCV among pregnant women in Canada is approximately 1% or nearly 3,500 women infected during pregnancy each year, half of whom may be unaware of their infection. Vertical transmission rates range from 5% to 6% among those with HCV and up to 10% among those with HCV/HIV coinfection.

While there are limited data available about the safety of direct-acting antiviral treatment during pregnancy or breastfeeding, the authors wrote that “the perinatal period is an excellent opportunity for screening, to diagnose women who are infected and engage them in care to cure the HCV infection.”

Current guidance in Canada recommends screening pregnant women for HCV based on the presence of risk factors, compared with the recommendation for universal screening in the U.S. and France, which has been shown to be cost-effective and identifies more pregnant women with HCV.

“The time has come to move toward universal HCV screening in women who are pregnant, with initial prenatal investigations that are then repeated based on risk factors in the third trimester,” Elwood and colleagues wrote. “All providers of prenatal care should consider HCV screening, diagnosis and referral to HCV treatment for women with HCV infection who are considering pregnancy.”

They also recommend counseling women who are pregnant about the potential for cure with new treatments and encourage them to seek treatment postpartum to prevent vertical transmission in future pregnancies.

“Achieving a 0% vertical transmission rate for HCV in Canada is possible, but it requires buy-in and action from a broad spectrum of health care providers and public health oicials,” the authors concluded. – by Talitha Bennett

Disclosure: Elwood reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.