HCV Testing and Management in Pregnant Adults
- Clinicians should perform HCV testing in all patients who are planning to get pregnant (A2) or are currently pregnant (B3), and screening should be repeated with each pregnancy (B3).
- See the NYSDOH AI guideline HCV Screening, Testing, and Diagnosis in Adults.
- Clinicians should advise pregnant patients diagnosed with chronic HCV (a positive HCV antibody test result and detectable HCV RNA) to defer treatment with DAAs until they are no longer pregnant or breastfeeding. (A2)
- If an individual with HCV becomes pregnant during DAA treatment, the clinician should
- Advise that the use of DAAs is not currently recommended during pregnancy because of insufficient safety data on the effect on the fetus.
- Discuss the risks and benefits of continuing treatment.
- Clinicians should refer pregnant patients diagnosed with HCV to a specialist experienced in managing HCV in pregnancy, e.g., hepatologist, gastroenterologist, infectious disease specialist, or high-risk obstetrician. (A3)
- If a pregnant patient with HCV has a substance use disorder, the clinician should provide or refer the patient for substance use treatment, including harm reduction services. (A3)
- See the NYSDOH AI guideline Substance Use Disorder Treatment in Pregnant Adults.
- Clinicians should advise pregnant and postpartum individuals with HCV monoinfection that HCV is not transmitted through breast milk and breastfeeding is considered safe. (B3)
- Clinicians should advise patients to discontinue breastfeeding if they have or develop cracked or bleeding nipples and to express and discard milk until the bleeding has resolved. (B3)
- Clinicians should refer infants born to mothers with HCV to pediatricians with experience in HCV care. (A3)
- See the CDC: Hepatitis C, Perinatal Infection 2018 Case Definition and the IDSA/AASLD: HCV in Pregnancy.
Contraceptive Use With HCV Treatment Containing RBV
- Before initiating RBV as part of an HCV treatment regimen in a patient of childbearing potential, clinicians should confirm a negative pregnancy test and advise patients to use 2 methods of birth control for the duration of DAA therapy and 6 months after completion. (A2)
- If a patient becomes pregnant while taking RBV, the clinician should discontinue the RBV. (A1)
- Contraindication: Clinicians should not prescribe RBV for any patient planning pregnancy within 6 months of the last RBV dose or any male patient with a pregnant partner. (A2)
