As the rate of hepatitis C infections continues to rise, the American College of Obstetricians and Gynecologists (ACOG) today issued new guidance aimed at providing critical information and recommendations on screening, treatment, management, and vaccination during pregnancy.
ACOG emphasizes the importance of routine and universal screening for hepatitis B and hepatitis C early in each pregnancy. Ideally, hepatitis C infection should be diagnosed before pregnancy, so preconception screening is recommended whenever possible.
Dr. Brenna Hughes, co-lead author of the guidance, noted that screening for hepatitis during pregnancy opens up an opportunity for dialogue between pregnant patients and their healthcare providers about hepatitis transmission, risk factors, and the importance of hepatitis B vaccination during pregnancy.
For patients with hepatitis B virus infection and a viral load above a certain threshold, ACOG recommends the use of antiviral medications during pregnancy to decrease the risk of transmitting the virus to the fetus. Cesarean delivery, however, is not recommended solely for reducing hepatitis B and C transmission.
While hepatitis C infection can be treated with antivirals, this treatment is not currently approved for use during pregnancy. Therefore, the focus is on preconception and postpartum therapy. Healthcare providers are encouraged to connect pregnant patients who test positive for hepatitis C during pregnancy with hepatitis care, so they can start treatment after giving birth and completing lactation. Additionally, patients who test positive for hepatitis C before pregnancy should complete antiviral therapy before becoming pregnant.
“When it comes to management of the virus, it is critical for both hepatitis B and hepatitis C that we assess the stability of maternal disease and how likely it is to cause pregnancy complications,” said Denise Jamieson, MD, MPH, FACOG, co-lead author of the guidance. “A multidisciplinary approach with input from a hepatitis specialist, such as a gastroenterologist or infectious disease specialist, is recommended. Patients should be counseled to abstain from alcohol, and recommended vaccinations should be discussed.”
The guidance also introduces a new recommendation for triple panel screening for hepatitis B. ACOG recommends this screening for pregnant patients who have not had a negative triple screen after turning 18, have not completed a hepatitis B vaccine series, or have ongoing risks for hepatitis B infection, regardless of vaccination status or testing history.
ACOG confirms that vaccination for hepatitis A, hepatitis B, or both is safe during pregnancy and recommended for certain groups of pregnant patients. They also note that both hepatitis A and hepatitis B are preventable through vaccines, while hepatitis C infections can be cured.
“Hepatitis C is the most commonly reported blood-borne infection in the United States, especially among those of childbearing age,” Dr. Hughes said. “Obstetrician–gynecologists play an integral role in addressing the serious public health threat posed by viral hepatitis. If we successfully raise awareness among both clinicians and patients, there is no reason why we can’t reverse course.”
