{"id":7371,"date":"2020-01-19T20:00:00","date_gmt":"2020-01-20T01:00:00","guid":{"rendered":"https:\/\/obgconnect.com\/library\/?p=7371"},"modified":"2025-05-14T09:25:14","modified_gmt":"2025-05-14T14:25:14","slug":"hepatitis-c-in-pregnancy","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/library\/2020\/01\/19\/hepatitis-c-in-pregnancy\/","title":{"rendered":"Hepatitis C in Pregnancy"},"content":{"rendered":"\n<ul class=\"wp-block-list\">\n<li><a href=\"#key-points\">Key Points<\/a><\/li>\n\n\n\n<li><a href=\"#background\">Background<\/a>\n<ul class=\"wp-block-list\">\n<li><a href=\"#incidence\">Incidence and Epidemiology<\/a><\/li>\n\n\n\n<li><a href=\"#screening\">Screening<\/a><\/li>\n\n\n\n<li><a href=\"#diagnosis\">Diagnosis<\/a><\/li>\n\n\n\n<li><a href=\"#impact\">Impact on Pregnancy<\/a><\/li>\n\n\n\n<li><a href=\"#treatment\">Treatment<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"#primary-sources\">Primary Sources<\/a>\n<ul class=\"wp-block-list\">\n<li><a href=\"#benova\">Benova et al.<\/a><\/li>\n\n\n\n<li><a href=\"#yeung\">Yeung et al.<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"#professional-recommendations\">Professional Recommendations<\/a>\n<ul class=\"wp-block-list\">\n<li><a href=\"#smfm\">SMFM<\/a><\/li>\n\n\n\n<li><a href=\"#usptf\">USPTF<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"#references\">References<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/obgconnect.com\/library\/2020\/03\/29\/labor-and-delivery-table-of-contents\/\"><strong>ObG L&amp;D<\/strong> Table of Contents<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"key-points\">KEY POINTS:&nbsp;<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hepatitis C infection affects 1 to 4 % of U.S pregnant women and 8% worldwide (Saab et al. Obstetrics &amp; Gynecology, 2020)<\/li>\n\n\n\n<li>HCV diagnosis has been increasing, with the highest rate occurring in persons 20 to 39 years of age, consistent with age groups most impacted by the US opioid crisis (CDC, Viral Hepatitis Surveillance Report 2019)<\/li>\n\n\n\n<li>The USPSTF recommends that all adults be screened at least once<\/li>\n\n\n\n<li>The CDC recommends screening in each pregnancy\n<ul class=\"wp-block-list\">\n<li>ACOG and SMFM recommend universal screening in pregnancy as risk-based screening almost 50% of maternal infections<\/li>\n\n\n\n<li>Early screening in first trimester may be beneficial<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Primary mode of transmission is percutaneous exposure to blood from injection of illicit drugs\n<ul class=\"wp-block-list\">\n<li>Other modes include sexual contact, occupational exposure to infected blood, tattooing, and vertical transmission in pregnancy<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The acute phase is infection through 6 months and is asymptomatic in 75% of cases\n<ul class=\"wp-block-list\">\n<li>15 to 45% clear infection in the first 6 months without treatment. Remainder have chronic HCV &nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Common presentations include\n<ul class=\"wp-block-list\">\n<li>Abdominal pain<\/li>\n\n\n\n<li>Nausea<\/li>\n\n\n\n<li>Anorexia<\/li>\n\n\n\n<li>Jaundice<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Without treatment, 15 to 30% develop cirrhosis within 20 years and about 1\/3 of those with cirrhosis develop hepatocellular carcinoma (WHO Hepatitis C Guidelines)<\/li>\n\n\n\n<li>Vertical transmission rate is 5.8% if HIV negative and about double if HIV positive (Saab et al. Obstetrics &amp; Gynecology, 2020)\n<ul class=\"wp-block-list\">\n<li>Risks decline if HIV infected and on contemporary anti-HIV medications<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The true prevalence of HCV infection in children is likely underestimated | Due poor ascertainment, the majority children with HCV infection likely go unidentified (Squires and Balistreri. Hepatol Commun, 2017)<\/li>\n\n\n\n<li>Antiviral agents in pregnancy have not been established and safety parameters at present are insufficient to recommend treatment in pregnancy<\/li>\n\n\n\n<li>Goal of screening is to provide linkage to care, improve monitoring for maternal, fetal and neonatal complications<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"background\">BACKGROUND:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"incidence\">Incidence and Epidemiology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In the US the incidence of infection is 1 to 4% of pregnant women | Worldwide it is 8%<\/li>\n\n\n\n<li>The prevalence has risen in the last 20 years due to the opioid epidemic<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"screening\">Screening<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The CDC recommends screening all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is &lt;0.1% (CDC Recommendations, 2020)<\/li>\n\n\n\n<li>&nbsp;SMFM\/ACOG recommend screening all pregnant women per updated recommendations 2021<\/li>\n\n\n\n<li>Noted risk factors for HCV infection include\n<ul class=\"wp-block-list\">\n<li>Injection or intranasal drug user (past or present)<\/li>\n\n\n\n<li>Long term hemodialysis patients<\/li>\n\n\n\n<li>Those who received tattoos or medical procedures in facilities where universal precautions were not utilized<\/li>\n\n\n\n<li>Transfusion or organ donor recipients<\/li>\n\n\n\n<li>Incarcerated women<\/li>\n\n\n\n<li>Women asking for STI testing<\/li>\n\n\n\n<li>Women with persistently elevated ALT<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Antibody testing (+\/-) reflex to HCV RNA viral count\n<ul class=\"wp-block-list\">\n<li>Antibodies are commonly positive after 2 to 6 months after exposure and persist throughout life.<\/li>\n\n\n\n<li>If very recent exposure or high risk, immediate and longitudinal RNA and LFT testing<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>HCV viremia can be positive 1 to 3 weeks after exposure and indicates active infection<\/li>\n\n\n\n<li>If anti-HCV antibody is positive, obtain quantitative nucleic acid test for HCV RNA<\/li>\n\n\n\n<li>Serial testing generally not indicated<\/li>\n\n\n\n<li>If viremia is noted, obtain the following labs at time of diagnosis\n<ul class=\"wp-block-list\">\n<li>Liver function tests (AST, ALT, bilirubin)<\/li>\n\n\n\n<li>Albumin<\/li>\n\n\n\n<li>Platelet count<\/li>\n\n\n\n<li>Prothrombin time<\/li>\n\n\n\n<li>HCV RNA HCV genotype (if not previously obtained)<\/li>\n\n\n\n<li>STI screening (HIV, syphilis, gonorrhea, chlamydia, and HBV)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Positive antibody but negative RNA viral count likely indicates a cleared past infection or false positive<\/li>\n\n\n\n<li>Most commonly, positive antibody and positive HCV RNA viral count indicates chronic infection (&gt; 6 months) but in some cases could indicate acute infection<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"impact\">Impact on Pregnancy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Many confounding comorbidities in the Hep C-infected pregnant population complicate observations regarding impact of infection on pregnancy<\/li>\n\n\n\n<li>Mothers with HCV more likely to have SGA, low birthweight and require NICU admission, need for assisted ventilation (SMFM Consult Series)<\/li>\n\n\n\n<li>Alanine aminotransferase (ALT) levels may decrease in 2nd and 3rd trimester but return to prepregnancy levels after delivery in pregnant women with HCV<\/li>\n\n\n\n<li>Odds of Intrahepatic cholestasis of pregnancy are 20x higher in women with HCV in pregnancy (Clin Res Hepatol Gastroenterol, 2017)<\/li>\n\n\n\n<li>Women with severe (bile acids &gt; 100micromole\/l) or early (&lt; 24 weeks) diagnosis of ICP should be screened for viral hepatitis<\/li>\n\n\n\n<li>Vertical transmission occurs almost exclusively in women with detectable HCV RNA | Unclear if degree of viremia correlates with rate of transmission<\/li>\n\n\n\n<li>&nbsp;50% of vertical transmission happens in the last month of pregnancy or during delivery (SMFM Consult Series)<\/li>\n\n\n\n<li>Vertical transmission rate\n<ul class=\"wp-block-list\">\n<li>HIV negative: 5.8% vertical transmission rate <\/li>\n\n\n\n<li>HIV positive: 10.8% (maybe lower if on contemporary anti-HIV drug management regimens)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Data on impact of pregnancy on course of chronic hepatitis C is mixed <\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Antepartum management prior to labor\n<ul class=\"wp-block-list\">\n<li>Third trimester assessment of fetal growth<\/li>\n\n\n\n<li>Antenatal testing for HCV diagnosis alone is not indicated<\/li>\n\n\n\n<li>Vaccination against HAV and HBV if not immune<\/li>\n\n\n\n<li>If diagnostic invasive testing is requested, advise patient that data regarding risk of transmission is reassuring but limited | No data for CVS, PUBS available<\/li>\n\n\n\n<li>Recommend abstain from all alcohol<\/li>\n\n\n\n<li>Can use acetaminophen but at maximum 2gm (versus 4gm) per day<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Intrapartum management\n<ul class=\"wp-block-list\">\n<li>Avoid routine AROM, internal fetal monitoring and episiotomy<\/li>\n\n\n\n<li>Avoid expectant management of term PROM | No alteration of management of preterm PROM due to inadequate data<\/li>\n\n\n\n<li>Vaginal or cesarean delivery per obstetric recommendations | No indication for cesarean secondary to Hepatitis C<\/li>\n\n\n\n<li>Even for women co-infected with HIV, there is no indication for cesarean for HCV independently<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Postpartum management\n<ul class=\"wp-block-list\">\n<li>Breastfeeding: Not associated with increased transmission | No reason to withhold breastfeeding | Avoid breastfeeding with cracked or bleeding nipples (SMFM Consult Series)<\/li>\n\n\n\n<li>Refer to hepatology or infectious disease specialist if not done prenatally | Confirm postpartum follow-up appointments with specialist<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Pediatric follow-up\n<ul class=\"wp-block-list\">\n<li>Of infants who acquire HCV\n<ul class=\"wp-block-list\">\n<li>20% will have an acute resolving infection | 50% will develop a chronic asymptomatic infection | 30% will develop a chronic active infection (Lopata et al. Pediatrics, 2020)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The American Academy of Pediatrics recommends testing for RNA in exposed infants at on 2 occasions at &gt; 1month of age OR antibody testing &gt; 18 months<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Note: <\/strong>Currently there are no anti-HCV therapies recommended for pregnancy (AASLD IDSA Guidelines) | Referral to a hepatologist or infectious disease specialist could be considered during pregnancy to expedite therapy after pregnancy<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"primary-sources\">PRIMARY SOURCES:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"benova\">Benova et al. Clin Infect Dis, 2014<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Meta-analysis on the risk of vertical HCV infection from HCV AB+ and RNA+ women\n<ul class=\"wp-block-list\">\n<li>HIV negative: 5.8% (95% CI 4.2%-7.8%) if their mother was HIV negative<\/li>\n\n\n\n<li>HIV positive: 10.8% (95% CI, 7.6%-15.2%)<\/li>\n\n\n\n<li>Maternal HIV co-infection was the most important determination of vertical transmission risk (aOR 2.56 [95% CI 1.5-4.43])<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"yeung\">Singh et al. JAMA, 2025<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Analysis of EHR data from 68 US healthcare organizations | 115,490,864 patients\n<ul class=\"wp-block-list\">\n<li>Aim of study was to determine the impact of updated universal HCV screening in 2020<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Following recommendations for universal HCV screening, increased screening rates were noted<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pregnant women: Screening increased from 52 to 117 tests per 1000 person-years (2014-2019) and from 141 to 253 tests per 1000 person-years after guidance change<\/li>\n\n\n\n<li>Nonpregnant women: Screening increased from 16 to 24 tests per 1000 person-years (2014-2019) and from 29 to 37 tests per 1000 person-years after guidance change<\/li>\n\n\n\n<li>Overall findings<ul><li>Higher Testing Uptake: By December 2022, 38.73% of pregnant women were ever HCV tested compared to 8.67% of nonpregnant women<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>However, suboptimal overall uptake remains: Only 39% of pregnant women and 9% of nonpregnant women were ever HCV tested, indicating room for improvement<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"professional-recommendations\">PROFESSIONAL RECOMMENDATIONS:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"smfm\">SMFM<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Screen all pregnant patients for HCV using anti-HCV antibodies in every pregnancy<\/li>\n\n\n\n<li>Other tests for confirmed active HCV in pregnancy\n<ul class=\"wp-block-list\">\n<li>AST, ALT, bilirubin | Albumin | Platelet count | Prothrombin time | Quantitative HCV RNA | HCV genotype (if not previously obtained) | STI screening (HIV, syphilis, gonorrhea, chlamydia, and HBV)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Advise abstention from alcohol<\/li>\n\n\n\n<li>Third trimester: Fetal growth may be obtained | Routine fetal monitoring not recommended &nbsp;<\/li>\n\n\n\n<li>Screen for viral hepatitis when patient has elevated bile acids or ICP diagnosis<\/li>\n\n\n\n<li>Defer antiviral treatment to the postpartum period<\/li>\n\n\n\n<li>Amniocentesis is recommended over chorionic villus sampling<\/li>\n\n\n\n<li>Hepatitis C positivity is not an indication for cesarean<\/li>\n\n\n\n<li>Avoid internal fetal monitoring, prolonged rupture of membranes, and episiotomy in hepatitis C positive women<\/li>\n\n\n\n<li>Do not discourage breast-feeding in hepatitis C positive patients<\/li>\n\n\n\n<li>Offer HAV and HBV vaccines for patients who are HCV positive<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"usptf\">USPSTF<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Screen adults ages 18 to 79 without known liver disease be screened for Hepatitis C<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"references\">REFERENCES:\u202f<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.cdc.gov\/hepatitis\/php\/statistics-surveillance\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">CDC: Surveillance for Viral Hepatitis<\/a><a href=\"https:\/\/www.cdc.gov\/hepatitis\/statistics\/2019surveillance\/HepC.htm\" target=\"_blank\" rel=\"noreferrer noopener\"> \u2013 United States, 2019<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/rr\/rr6902a1.htm\" target=\"_blank\" rel=\"noreferrer noopener\">CDC Recommendations for Hepatitis C Screening Among Adults \u2014 United States, 2020<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/publications.smfm.org\/publications\/577-society-for-maternal-fetal-medicine-consult-series-56\/\" target=\"_blank\" rel=\"noreferrer noopener\">SMFM Consult Series 56: Hepatitis C in pregnancy\u2014updated guidelines<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789241550345\" target=\"_blank\" rel=\"noreferrer noopener\">WHO: Guidelines for the screening, care, and treatment of persons with chronic hepatitis C infection<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29404447\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hepatitis C virus infection in children and adolescents (Squires and Balistreri. Hepatol Commun, 2017)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22765955\/\" target=\"_blank\" rel=\"noreferrer noopener\">Expected and actual case ascertainment and treatment rates for children infected with hepatitis C in Florida and the United States: epidemiologic evidence from statewide and nationwide surveys (Delgado-Borrego et al. J Pediatrics, 2012)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27542514\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hepatitis C infection and intrahepatic cholestasis of pregnancy: A systematic review and meta-analysis (Clin Res Hepatol Gastroenterol, 2017)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24928290\/\" target=\"_blank\" rel=\"noreferrer noopener\">Vertical transmission of hepatitis C virus: systematic review and meta-analysis (Benova et al. Clin Infect Dis, 2014)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32168214\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Urgent Need for Hepatitis C Screening in Pregnant Women (Saab et al. Obstetrics &amp; Gynecology, 2020)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.hcvguidelines.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">AASLD-IDSA HCV Guidance Panel. Hepatitis C guidance <\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16267758\/\" target=\"_blank\" rel=\"noreferrer noopener\">Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy (Mast et al. J Infect Dis, 2005)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32060140\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hepatitis C Testing Among Perinatally Exposed Infants (Lopata et al. Pediatrics, 2020)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/hepatitis-c-screening\" target=\"_blank\" rel=\"noreferrer noopener\">USPSTF: Hepatitis C Virus Infection in Adolescents and Adults<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.acog.org\/clinical\/clinical-guidance\/clinical-practice-guideline\/articles\/2023\/09\/viral-hepatitis-in-pregnancy\" target=\"_blank\" rel=\"noreferrer noopener\">ACOG Clinical practice Guideline 6: Viral hepatitis in pregnancy<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2830742\" target=\"_blank\" rel=\"noreferrer noopener\">Hepatitis C Virus Screening in Pregnant and Nonpregnant Women After Universal Screening Guidelines (Singh et al. JAMA, 2025) <\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>KEY POINTS:&nbsp; BACKGROUND: Incidence and Epidemiology Screening Diagnosis Impact on Pregnancy Treatment Note: Currently there are no anti-HCV therapies recommended for pregnancy (AASLD IDSA Guidelines) | Referral to a hepatologist or infectious disease specialist could be considered during pregnancy to expedite therapy after pregnancy PRIMARY SOURCES: Benova et al. Clin Infect Dis, 2014 Singh et [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":3717,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[11],"tags":[],"class_list":["post-7371","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-labor-and-delivery"],"acf":[],"featured_image_urls_v2":{"full":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured-150x150.jpg",150,150,true],"medium":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured-300x199.jpg",300,199,true],"medium_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"1536x1536":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"2048x2048":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"ultp_layout_landscape_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"ultp_layout_landscape":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"ultp_layout_portrait":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"ultp_layout_square":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"woocommerce_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured-300x265.jpg",300,265,true],"woocommerce_single":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg",400,265,false],"woocommerce_gallery_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured-100x100.jpg",100,100,true]},"post_excerpt_stackable_v2":"<p>Key Points Background Incidence and Epidemiology Screening Diagnosis Impact on Pregnancy Treatment Primary Sources Benova et al. Yeung et al. Professional Recommendations SMFM USPTF References ObG L&amp;D Table of Contents KEY POINTS:&nbsp; Hepatitis C infection affects 1 to 4 % of U.S pregnant women and 8% worldwide (Saab et al. Obstetrics &amp; Gynecology, 2020) HCV diagnosis has been increasing, with the highest rate occurring in persons 20 to 39 years of age, consistent with age groups most impacted by the US opioid crisis (CDC, Viral Hepatitis Surveillance Report 2019) The USPSTF recommends that all adults be screened at least once&hellip;<\/p>\n","category_list_v2":"<a href=\"https:\/\/obgconnect.com\/library\/category\/labor-and-delivery\/\" rel=\"category tag\">ObG L&amp;D\u2122<\/a>","author_info_v2":{"name":"mharris","url":"https:\/\/obgconnect.com\/library\/author\/mharris\/"},"comments_num_v2":"0 comments","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Hepatitis C in Pregnancy - OBG LIBRARY<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/obgconnect.com\/library\/2020\/01\/19\/hepatitis-c-in-pregnancy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hepatitis C in Pregnancy - OBG LIBRARY\" \/>\n<meta property=\"og:description\" content=\"KEY POINTS:&nbsp; BACKGROUND: Incidence and Epidemiology Screening Diagnosis Impact on Pregnancy Treatment Note: Currently there are no anti-HCV therapies recommended for pregnancy (AASLD IDSA Guidelines) | Referral to a hepatologist or infectious disease specialist could be considered during pregnancy to expedite therapy after pregnancy PRIMARY SOURCES: Benova et al. Clin Infect Dis, 2014 Singh et [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/obgconnect.com\/library\/2020\/01\/19\/hepatitis-c-in-pregnancy\/\" \/>\n<meta property=\"og:site_name\" content=\"OBG LIBRARY\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/theobgproject\/\" \/>\n<meta property=\"article:published_time\" content=\"2020-01-20T01:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-05-14T14:25:14+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2021\/02\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"400\" \/>\n\t<meta property=\"og:image:height\" content=\"265\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"mharris\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@TheObGProject\" \/>\n<meta name=\"twitter:site\" content=\"@TheObGProject\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"mharris\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/\"},\"author\":{\"name\":\"mharris\",\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/#\\\/schema\\\/person\\\/a254db6839321441bafc627dfdf4e842\"},\"headline\":\"Hepatitis C in Pregnancy\",\"datePublished\":\"2020-01-20T01:00:00+00:00\",\"dateModified\":\"2025-05-14T14:25:14+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/\"},\"wordCount\":1531,\"publisher\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2021\\\/02\\\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg\",\"articleSection\":[\"ObG L&amp;D\u2122\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/\",\"url\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/\",\"name\":\"Hepatitis C in Pregnancy - OBG LIBRARY\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2021\\\/02\\\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg\",\"datePublished\":\"2020-01-20T01:00:00+00:00\",\"dateModified\":\"2025-05-14T14:25:14+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#primaryimage\",\"url\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2021\\\/02\\\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg\",\"contentUrl\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2021\\\/02\\\/igordoon-primus-mIXJiFzQjIA-unsplash-featured.jpg\",\"width\":400,\"height\":265},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/2020\\\/01\\\/19\\\/hepatitis-c-in-pregnancy\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Hepatitis C in Pregnancy\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/#website\",\"url\":\"https:\\\/\\\/obgconnect.com\\\/library\\\/\",\"name\":\"OBG LIBRARY\",\"description\":\"For Physicians. 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