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Recommendations address ‘public health concern’ of hepatitis C in pregnancy

Brenna Hughes

The Society for Maternal-Fetal Medicine recently issued its first-ever recommendations for pregnant women with hepatitis C — a segment of population that data suggest impacts 4% of pregnant women in the United States.

“Hepatitis C is an important public health concern for pregnant women,” Brenna L. Hughes, MD, MSc, an author of the recommendations, told Healio Family Medicine.

“We wanted to bring attention to the current recommendations for screening women in pregnancy,” Hughes, who is also the director of the maternal fetal medicine fellowship at the Duke University School of Medicine, continued. “Ideally women can be cured of hepatitis C prior to achieving pregnancy, but for those who come into pregnancy with the infection, we wanted to review and promote best practices.”

According to researchers, risk factors for hepatitis C include chronic liver disease, seeking treatment for other STDs, having a history of incarceration, receiving blood products or an organ transplant, getting a medical procedure or tattoo in an unregulated setting, undergoing long-term hemodialysis, and snorting or injecting illegal drugs.

Recommendations that Hughes and colleagues labelled “best practice” or “strong” for obstetric care providers include:

• counseling all patients to refrain from alcohol;
• screening women at increased risk for hepatitis C for anti-hepatitis C antibodies at the inaugural prenatal visit;
• conducting additional screening later in the pregnancy in women with new or persistent risk factors for hepatitis C, even if the first test results were negative;
• screening pregnant women with hepatitis C for other STDs;
• using direct-acting antiviral agents only in the clinical trial setting or postponing antiviral treatment until after pregnancy;
• not performing cesarean delivery exclusively for hepatitis C indications;
• avoiding episiotomy, prolonged rupture of membranes, and internal fetal monitoring while managing labor in women with hepatitis C; and
• not discouraging breast-feeding based in women with hepatitis C.

Researchers said their recommendations align with those issued by the CDC, WHO, AAP,

American College of Obstetricians and Gynecologists (ACOG), and several other medical organizations.

Hughes added that the Society for Maternal-Fetal Medicine recommendations also address what she called “the biggest misconception” surrounding pregnant women with hepatitis C.

“Some women assume that because they have this infection, it’s guaranteed that their infant will have it, too. But we can reassure most women that the risk is in the range of 5%, which is relatively low," she said.

Research on how treatments for hepatitis C affect pregnant women, or how pregnancy alters the uptake, metabolism and effectiveness of medications is lacking, according to Hughes.

A member of the ACOG agreed.

“More research on hepatitis C during pregnancy is needed to further our understanding of the virus and its treatment," Christopher M. Zahn, MD, ACOG vice president of practice activities, said in a press release. “With further information, obstetric care providers will be able to adequately screen for hepatitis C and counsel pregnant women who are hepatitis C-positive.”

The Society for Maternal-Fetal Medicine recommendations were endorsed by ACOG. – by Janel Miller

Disclosures: Healio Family Medicine was unable to determine the authors and Zahn’s relevant financial disclosures prior to publication.