Summary: HCV in Pregnancy


Recommendation for Universal Hepatitis C Screening in Pregnancy

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.) I, B

Whom to Treat

Recommendation Regarding HCV Treatment and Pregnancy

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. I, B


Monitoring During Pregnancy

Recommendations for Monitoring HCV-Infected Women During Pregnancy

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.  I, B
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. I, B
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. I, B
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. I, B


Postpartum Issues

Recommendations Regarding Breastfeeding and Postpartum Care for HCV-Infected Women

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. I, B
Women with HCV infection should have their HCV RNA reevaluated after delivery to assess for spontaneous clearance. I, B


Last update: 
December 19, 2023