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).
