II. Epidemiology
- Prevalence of Hepatitis C Virus Prevalence in pregnancy has increased dramatically since 2000 in the United States
III. Indications: Screening Pregnancy
- See Hepatitis C for risk factors
- Universal Screening for all U.S. pregnant women in early prenatal period (per CDC)
IV. Pathophysiology
- Vertical transmission Risk
- Mother HCV Ab positive and HCV RNA negative: 1.7% vertical transmission rate of HCV
- Mother HCV Ab Positive and HCV RNA positive: 4.3% vertical transmission rate of HCV
- Mother HCV Ab Positive and Comorbid HIV positive: 19.4% vertical transmission rate of HCV
- Factors that do not impact transmission
- Ceserean section does not reduce transmission
- Breast Feeding does not increase transmission rate
V. Labs: Diagnosis of Hepatitis C in infant
- Initial False Positive testing due to persists maternal HCV antibodies in infant for upwards of one year
- Obtain initial HCV RNA NAT (Nucleic Acid Test) at 2 to 6 months in all infants exposed to HCV positive mothers
- Catch up testing for all infants 7 to 17 months who have not yet been tested
- Interpretation
- Negative HCV RNA NAT
- Single NAT test at 2 to 6 months is sufficiently accurate to exclude HCV Infection in infants
- Positive HCV RNA NAT
- See Management below
- Two samples are no longer required
- Negative HCV RNA NAT
VI. Management: HCV Positive infant
- Refer to pediatric specialists in HCV Infection
- Spontaneous clearance without treatment occurs by age 5 years in 20 to 40% of HCV perinatally infected infants
- Some HCV Antivirals are approved for age 3 years old and older
- Monitor Alanine transaminase and markers of Hepatic Fibrosis
- HCV complications are typically delayed for decades
- However, advanced fibrosis and Cirrhosis has occurred in HCV positive teens with perinatal acquired HCV
VII. Management: HCV positive mother
- Gastroenterology or infectious disease referral for Hepatitis C infected mother
- Most Antiviral treatment is contraindicated in pregnancy
- Includes the older Interferon and Ribavirin protocol contraindicated in pregnancy (Ribavirin is Teratogenic)