New Screening Guidelines for Pregnant Women at HCV Risk

Pregnant women who are at increased risk for hepatitis C (HCV) should be screened for the virus at their earliest prenatal visit, first-ever guidelines from the Society for Maternal-Fetal Medicine (SMFM) suggest.

A woman who tests negative, but exhibits persistent or new HCV risk factors, should be screened again later in her pregnancy, according to the the Washington, DC-based non-profit, which aims to reduce pregnancy complications.

As many as 8% of pregnant women worldwide are infected with hepatitis C, according to the organization.

“These guidelines are an updated comprehensive obstetric-focused compilation of some of the recommendations that already exist from the Centers for Disease Control and Prevention (CDC) and the American College of Obstetrics and Gynecology (ACOG),’’ lead author and SMFM member Brenna L. Hughes, MD, MSc, told MD Magazine. The SMFM also considered new literature on the topic in issuing the guidelines, she said.

For HCV-positive women, the recommendations include screening for other sexually transmitted infections (STIs) and vaccinating for hepatitis A and B during pregnancy. These patients should avoid internal fetal monitoring, prolonged rupture of membranes and episiotomy.

“Importantly, the guidelines also are meant to bring attention to obstetric providers that there are new therapies that can essentially cure hepatitis C outside of pregnancy, so it is important to link women to care either prior to of following pregnancy,” Hughes said.

While highly effective treatments for HCV exist, they are not currently approved for use during pregnancy.

“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 promote best practices,” said Kerri Wade, MPA, the SMFM’s director of communications.

"A better understanding of the risks and potential treatments for HCV in pregnancy are desperately needed,’’ Wade said.

The rate of hepatitis C infections has increased in the US in conjunction with the opioid crisis. Most new HCV cases arise among injecting drug users. Other risk factors include long-term hemodialysis; a tattoo or medical procedure obtained in an unregulated setting; an organ transplant or blood products; a history of incarceration; other sexually transmitted infections; and chronic liver disease, according to the SMFM.

“Obstetric care providers will likely encounter HCV more than they have in the past,” said Hughes, an associate professor of obstetrics and gynecology at Duke University Medical Center in Durham, North Carolina.

That means maternal-fetal medicine physicians, OBGYNs, nurse-midwives and family doctors should be aware of these guidelines and work towards implementing them their practice.

“We also want to remind obstetrical care providers that vaccination for hepatitis A and B is safe and recommended during pregnancy for women with newly diagnosed hepatitis C,” Wade noted. She said that there is a risk — albeit small — for a pregnant woman to transmit HCV to her fetus.

The guidelines also state that HCV alone is not an indicator for Caesarian section and that HCV-positive women can breastfeed.

However, if a woman requests invasive prenatal diagnostic testing, she should be counseled that data on risk is limited. Amniocentesis is preferred over chorionic villus sampling, according to the SMFM.

“More research on HCV during pregnancy is needed to further our understanding of the virus and its treatment,” said ACOG Vice President of Practice Activities, Christopher M. Zahn, MD. “With further information, obstetric care providers will be able to adequately screen for HCV and counsel pregnant women who are HCV-positive.”

The ACOG endorsed the guidelines.

A press release was made available.