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Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017.

Publication ,  Journal Article
Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, ; Dotters-Katz, SK; Kuller, JA; Hughes, BL
Published in: Am J Obstet Gynecol
September 2021

In the United States, it is estimated that 1% to 4% of pregnant women are infected with hepatitis C virus, which carries approximately a 5% risk of transmission from mother to infant. Hepatitis C virus can be transmitted to the infant in utero or during the peripartum period, and infection during pregnancy is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birthweight. The purpose of this document is to discuss the current evidence, provide updated recommendations regarding screening, review treatment, and address management of hepatitis C virus during pregnancy. The following are the Society for Maternal-Fetal Medicine's recommendations: (1) We suggest that third trimester assessment of fetal growth may be performed, but antenatal testing is not indicated in the setting of hepatitis C virus diagnosis alone (GRADE 2C); (2) we suggest screening for viral hepatitis in patients with a diagnosis of intrahepatic cholestasis of pregnancy at an early gestational age or with high levels of bile acids (GRADE 2C); (3) we recommend that obstetrical providers screen all pregnant patients for hepatitis C virus by testing for anti-hepatitis C virus antibodies in every pregnancy (GRADE 1B); (4) we suggest that obstetrical care providers screen hepatitis C virus-positive pregnant patients for other sexually transmitted infections (if not done previously), including human immunodeficiency virus, syphilis, gonorrhea, chlamydia, and hepatitis B virus (GRADE 2C); (5) we recommend vaccination against hepatitis A and B viruses (if not immune) for patients with hepatitis C virus (GRADE 1B); (6) we recommend that direct-acting antiviral regimens only be initiated in the setting of a clinical trial during pregnancy and that people who become pregnant while taking a direct-acting antiviral should be counseled in a shared decision-making framework about the risks and benefits of continuation (GRADE 1C); (7) we suggest that if prenatal diagnostic testing is requested, patients are counseled that data regarding the risk of vertical transmission are reassuring but limited (GRADE 2C); (8) we recommend against cesarean delivery solely for the indication of hepatitis C virus (GRADE 1B); (9) we suggest that obstetrical care providers avoid internal fetal monitors and early artificial rupture of membranes when managing labor in patients with hepatitis C virus unless necessary in the course of management (ie, when unable to trace the fetal heart rate with external monitors and the alternative is proceeding with cesarean delivery) (GRADE 2B); (10) we recommend that hepatitis C virus status not alter standard breastfeeding counseling and recommendations unless nipples are cracked or bleeding (GRADE 1A).

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Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

September 2021

Volume

225

Issue

3

Start / End Page

B8 / B18

Location

United States

Related Subject Headings

  • Ultrasonography, Prenatal
  • Societies, Medical
  • Prenatal Diagnosis
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Practice Guidelines as Topic
  • Obstetrics & Reproductive Medicine
  • Infectious Disease Transmission, Vertical
  • Humans
  • Hepatitis C, Chronic
 

Citation

APA
Chicago
ICMJE
MLA
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Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, ., Dotters-Katz, S. K., Kuller, J. A., & Hughes, B. L. (2021). Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017. Am J Obstet Gynecol, 225(3), B8–B18. https://doi.org/10.1016/j.ajog.2021.06.008
Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, Brenna L., Sarah K. Dotters-Katz, Jeffrey A. Kuller, and Brenna L. Hughes. “Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017.Am J Obstet Gynecol 225, no. 3 (September 2021): B8–18. https://doi.org/10.1016/j.ajog.2021.06.008.
Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, Dotters-Katz SK, Kuller JA, Hughes BL. Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017. Am J Obstet Gynecol. 2021 Sep;225(3):B8–18.
Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, Brenna L., et al. “Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017.Am J Obstet Gynecol, vol. 225, no. 3, Sept. 2021, pp. B8–18. Pubmed, doi:10.1016/j.ajog.2021.06.008.
Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org, Dotters-Katz SK, Kuller JA, Hughes BL. Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017. Am J Obstet Gynecol. 2021 Sep;225(3):B8–B18.
Journal cover image

Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

September 2021

Volume

225

Issue

3

Start / End Page

B8 / B18

Location

United States

Related Subject Headings

  • Ultrasonography, Prenatal
  • Societies, Medical
  • Prenatal Diagnosis
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Practice Guidelines as Topic
  • Obstetrics & Reproductive Medicine
  • Infectious Disease Transmission, Vertical
  • Humans
  • Hepatitis C, Chronic