Society for Maternal-Fetal Medicine (SMFM) issues guidelines for HCV in pregnancy

The Society for Maternal-Fetal Medicine (SMFM) has issued guidelines for screening and management of Hepatitis C infection in pregnancy.  

The guidelines were published ahead of print in American Journal of Obstetrics and Gynecology.

It is estimated that on average nearly 1-2.5% of pregnant women in US are infected with the virus and the risk of vertical transmission is 5%.

The recommendations are:

1) All women who are at increased risk for Hepatitis C should get tested for anti-HCV antibodies at their first prenatal visit. If the risk persists till later in pregnancy or new risk factor arise, the screening should be repeated again. (GRADE 1B)

According to American Liver Foundation the risk of Hepatitis C is increased if:

• Shared needles to inject drugs or straws to inhale them
• Had tattoos or body piercings in an unclean environment using unsterile equipment
• Worked in a place where you came in contact with infected blood or needles, for example, healthcare workers
• Received a blood transfusion or organ transplant before July 1992
• Received a blood product for clotting problems made before 1987
• Needed to have your blood filtered by a machine (hemodialysis) for a long period of time because your kidneys weren’t working
• Were born to a mother with HCV
• Had unprotected sex with multiple partners
• Have or had a sexually transmitted disease
• Have HIV

2) All HCV positive pregnant women should be screened for other sexually transmitted diseases (STDs) including HIV, syphilis, gonorrhea, chlamydia, and hepatitis B virus (HBV). (GRADE 1B)

3) All patients with HCV, including pregnant women should be advised to refrain from consuming alcohol. (Best Practice)

4) Direct-acting antiviral medications (DAA) are not to be used in pregnancy, except in settings of clinical trials. The treatment should be initiated after the delivery of the patient in the postpartum period. (Grade 1C).

5) If invasive prenatal testing is requested than amniocentesis is preferred over chorionic villus sampling (CVS) because of limited data on the risk of vertical transmission for CVS over amniocentesis. (Grade 2C).

 6) HCV infection solely is not an indication for Cesarean section in absence of other obstetric indications. (GRADE 1B)

7) Internal fetal monitoring, prolonged rupture of membranes, and episiotomy should be avoided during labor in HCV+ women (Grade 1B).

8) Positive HCV status is not a contraindication for breast feeding. (Grade 1A).