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HCV Screening in Pregnancy

HCV in Pregnancy Overview | HCV Screening in Pregnancy | HCV: Antepartum, Intrapartum and Postpartum Management  | HCV Treatment in Pregnancy and Postpartum | HCV Professional Resources

Review the latest recommendations with

Alex Miller, MD and Katherine S. Kohari, MD, FACOG

Dr. Miller is a Maternal-Fetal Medicine fellow at the Yale School of Medicine

Dr. Kohari, a Maternal-Fetal Medicine specialist, is an Assistant Professor and the Medical Director for MFM Outpatient Services in the Department of Obstetrics and Gynecology at the Yale School of Medicine in New Haven, CT

Learning Objectives

Upon completion of this activity, participants should be better able to:

  • Understand the current guidance for HCV screening during pregnancy
  • Differentiate universal versus risk-based screening strategies
  • Request and interpret testing for HCV infection in pregnancy
  • Relay current guidance for postnatal screening for neonates exposed to HCV during pregnancy



Current Guidance

Universal screening for HCV is being more commonly recommended during pregnancy


  • Prenatal HCV testing as a part of routine prenatal care is recommended with each pregnancy (IB)

USPTF (2020)

  • Pregnant adults should be screened
  • Consider screening in pregnant persons younger than 18 years old

CDC (2020)

  • All pregnant women should be screened during each pregnancy unless local HCV prevalence is <0.1%
  • Consider repeat testing later in pregnancy if ongoing risk factors
    • Persons with ongoing use of injectable drugs who share needles, syringes, or other drug preparation equipment
    • Persons with selected medical conditions including maintenance hemodialysis

ACOG Practice Advisory (2021; reaffirmed 2022) – Endorsed by SMFM

  • Universal screening for HCV is recommended for all pregnant individuals during each pregnancy at the first prenatal blood assessment to identify HCV infection and infants who should receive testing at subsequent pediatric visits

Universal versus Risk-Based Screening

HCV Screening Benefits

  • Pregnancy and immediate postpartum care may be a person’s only opportunity for healthcare
  • Identification during pregnancy allows avoidance of procedures that may increase risk of transmission, identification of at risk neonates, and coordination for treatment following pregnancy
  • Treatment during pregnancy may be accomplished through enrollment in active clinical trials or may be more widely recommended in the future if research regarding the safety and efficacy of DAA treatment in pregnancy is reassuring

HCV Screening Potential Harms

  • Pain or complication associated with blood draw or liver biopsy
  • Anxiety/psychological concerns relating to test results (false positives, true positives, waiting period)
  • Legal ramifications (infant custody, disclosure of illegal behaviors)
  • Social ramifications of diagnosis (family, sexual partners, insurability, employability)
  • Issues regarding treatment access or adverse effects of medication

Risk-Based Screening Concerns

  • Underreporting of risk factors due to patient concern for provider discrimination or legal ramifications
  • HCV may complicate pregnancies without reported risk factors (Boudova et al. Open Forum Infect Dis, 2018)
  • Risk factor screening questionnaire noted to have sensitivity of 85% and specificity of 52% in Cleveland, OH (Waruingi et al. J Neonatal Perinatal Med, 2015).

Is Universal Screening Cost Effective?

  • Yes! Universal screening remains cost effective until the prevalence of HCV drops below 0.03% (Chaillon et al. Clin Infect Dis, 2019)

Testing Algorithms – CDC Recommendations

Screening in Persons without a report history of HCV

  1. Obtain HCV antibody testing (anti-HCV). 
  2. If HCV antibody testing is positive/reactive, obtain HCV RNA testing (viral load assessment).
    • Detection of HCV RNA is consistent with current HCV infection
    • Non-detection of HCV RNA is generally not consistent with current HCV infection
      • Consider use of another HCV antibody assay to differentiate resolved HCV infection from false positive result
      • Repeat HCV RNA if concern for HCV exposure in the past 6 months (identification of early infection given antibody make take 6-10 weeks to appear after onset of clinical illness)

Screening in Persons with a Reported History of Treated HCV

  • If the patient has a history of treated HCV with subsequent viral clearance, use HCV RNA (viral load) to screen for reinfection if indicated
  • Re-infection screening recommended annually if concerned for ongoing risk of exposure or in the setting of unexplained hepatic dysfunction

Assessment of Viral Clearance Following Treatment

  • Obtain HCV RNA testing (viral load) 12 weeks following completion of therapy.
  • Treatment success is defined as an undetectable viral load

Infant Screening Following Exposure During Pregnancy 


  • All children born to HCV-infected women should be tested for HCV with an antibody-based test at or after 18 months (IA)

CDC (2020)

  • Infants should undergo HCV RNA testing at or after 2 months OR anti-HCV antibody testing at or after 18 months


  • Anti-HCV antibodies may be used to test after 18 months
  • If requested by family, may use serum HCV RNA for testing prior to 18 months (do not test prior to 2 months)

AAP (1998)

  • Testing for anti-HCV should be performed after 12 months of age


  • SMFM, ACOG, USPTF, CDC, and AASLD/IDSA recommend universal screening for HCV during pregnancy
  • Universal screening is cost effective and results in increased detection of HCV in pregnancy
  • Anti-HCV antibody testing should be used for screening with subsequent confirmatory testing using HCV RNA (viral load)
  • Screening for infants following exposed pregnancies is recommended with anti-HCV antibodies after 18 months

Learn More – Primary Sources: 

The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America Present HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

US Preventative Services Task Force Recommendation Statement: Screening for Hepatitis C Virus Infection in Adolescents and Adults

CDC Recommendations for Hepatitis C Screening Among Adults – United States, 2020

ACOG Clinical Practice Guideline 6: Viral Hepatitis in Pregnancy | ACOG

SMFM: Consult Series #56: Hepatitis C in pregnancy—updated guidelines

Risk-Based Hepatitis C Screening in Pregnancy is Less Reliable Than Universal Screening: A Retrospective Chart Review

Hepatitis C Virus universal screening versus risk based selective screening during pregnancy

Cost-effectiveness of Universal Hepatitis C Virus Screening of Pregnant Women in the United States

CDC Recommended Testing Sequence for Identifying Current Hepatitis C Virus Infection

NASPGHAN Practice Guidelines: Diagnosis and Management of Hepatitis C Infection in Infants, Children, and Adolescents

American Academy of Pediatrics Hepatitis C Virus Infection

Commercial Support

This educational activity is supported by an independent educational grant from Gilead Sciences

Faculty Disclosures

Dr. Miller has no relevant financial relationships to disclose

Dr. Kohari has no relevant financial relationships to disclose