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Hepatitis C in Pregnancy: Review of Current Knowledge and Updated Recommendations for Management

Page, Charlotte M. MD*; Hughes, Brenna L. MD, MSc; Rhee, Eleanor H.J. MD; Kuller, Jeffrey A. MD§

Obstetrical & Gynecological Survey: June 2017 - Volume 72 - Issue 6 - p 347–355
doi: 10.1097/OGX.0000000000000442
CME ARTICLES
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CME

Importance An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which carries approximately a 6% risk of mother-to-infant transmission.

Objectives The aims of this article are to review the current evidence on HCV in pregnancy and to provide updated recommendations for management.

Evidence Acquisition Original research articles, review articles, and guidelines on HCV in general and specifically in pregnancy were reviewed, as were drug safety profiles from the Food and Drug Administration.

Results Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection. However, it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight, and can be transmitted to the infant in utero or during the peripartum period. No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk. To date, no treatment regimens for HCV have been approved for use in pregnancy, but the new ribavirin-free, direct-acting antiviral regimens are being used with high efficacy outside pregnancy.

Conclusions and Relevance Hepatitis C virus infection in pregnancy generally does not adversely affect maternal well-being but is associated with adverse effects on the fetus because of pregnancy complications and vertical transmission. There are currently no approved treatment regimens for HCV in pregnancy; this should be an active area of research in obstetrics.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completion of this educational activity, the obstetrician/gynecologist should be able to summarize current knowledge on the impact of pregnancy on maternal chronic hepatitis C, identify risks that maternal hepatitis C infection presents to the fetus, discuss the evidence on perinatal interventions and the risk of vertical transmission of HCV, and outline how to screen for, diagnose, and provide appropriate prenatal care for hepatitis C in pregnancy.

*Resident, †Associate Professor, ‡Assistant Professor, and §Professor, Obstetrics and Gynecology, Duke University, Durham, NC

The authors have disclosed that the US Food and Drug Administration has not approved the use of any antivirals for the treatment of hepatitis C virus in pregnancy as discussed in this article. Please consult the products’ labeling for approved information.

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Charlotte M. Page, MD, Department of Obstetrics and Gynecology, Duke University Medical Center, Baker House 236, Durham, NC 27710. E-mail: charlotte.page@duke.edu.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.