Summary: HCV in Pregnancy
Testing
Recommendation for Universal Hepatitis C Screening in Pregnancy
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RECOMMENDED
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RATING 
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As part of prenatal care, all pregnant persons should be tested for HCV infection with each pregnancy, ideally at the initial visit. (See Recommendations for Initial HCV Testing and Follow-Up.)
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I, B
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Whom to Treat
Recommendation Regarding HCV Treatment and Pregnancy
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RECOMMENDED
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RATING
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For women of reproductive age with known HCV infection, antiviral therapy is recommended before considering pregnancy, whenever practical and feasible, to reduce the risk of HCV transmission to future offspring.
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I, B
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Monitoring During Pregnancy
Recommendations for Monitoring HCV-Infected Women During Pregnancy
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RECOMMENDED
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RATING
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HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant persons to assess the risk of mother-to-child transmission (MTCT) and severity of liver disease.
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I, B
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All pregnant persons with HCV infection should receive prenatal and intrapartum care that is appropriate for their individual obstetric risk(s) as there is no currently known intervention to reduce MTCT.
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I, B
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In HCV-infected pregnant persons with pruritus or jaundice, there should be a high index of suspicion for intrahepatic cholestasis of pregnancy (ICP) with subsequent assessment of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and serum bile acids.
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I, B
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HCV-infected persons with cirrhosis should be counseled about the increased risk of adverse maternal and perinatal outcomes. Antenatal and perinatal care should be coordinated with a maternal-fetal medicine (ie, high-risk pregnancy) obstetrician.
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I, B
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Postpartum Issues
Recommendations Regarding Breastfeeding and Postpartum Care for HCV-Infected Women
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RECOMMENDED
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RATING
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Breastfeeding is not contraindicated in women with HCV infection, except when the mother has cracked, damaged, or bleeding nipples, or in the context of HIV coinfection.
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I, B
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Women with HCV infection should have their HCV RNA reevaluated after delivery to assess for spontaneous clearance.
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I, B
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