In one of the latest installments of the Society for Maternal-Fetal Medicine’s (SMFM’s) consult series, published in November 2017, an expert panel shared 8 recommendations for the screening, treatment, and management of hepatitis C virus (HCV) during pregnancy. The document, which was also endorsed by the American College of Gynecologists and Obstetricians, is the first to provide a comprehensive summary of evidence-based guidelines for this population.
Given that the prevalence of HCV in pregnant women is nearly 8% worldwide and 1.5% to 2% in the United States, and illicit drug use—the primary mode of HCV transmission—continues to be widespread, the guidelines are an important resource for obstetric care providers, says SMFM Publication Committee vice chair, Jeffrey Kuller, MD, an MFM specialist at Duke.
One of the document’s most important recommendations, he notes, is that providers be aware of the risk factors for HCV and screen women who are at increased risk during their first prenatal visit. Even if a woman tests negative for HCV early on, the committee recommends that, if she continues to exhibit at-risk behavior, she should be re-tested later in her pregnancy.
“It’s important that we have a low threshold for screening patients who meet risk factors,” Kuller says. “And we shouldn’t assume anything about a patient based solely on her appearance; we need to ask all of our patients questions about their history, particularly with illegal drugs, so we can assess their risk of HCV.” The document provides a table (Table 1) of HCV risk factors to help obstetric care providers determine who should be screened during pregnancy.
Another important recommendation, he says, is that pregnant women who have tested positive for HCV should be screened for other sexually transmitted infections (STIs) because they have overlapping risk factors and have the potential to cause adverse effects during pregnancy. Also critical is the group’s recommendation against treating HCV during pregnancy outside of a clinical trial because of the lack of clinical safety data and the recommendation against cesarean delivery solely for the indication of HCV.
“There were a lot of unknowns before these recommendations came out,” Kuller says. “So, while I don’t think the document says anything incredibly surprising, I think it’s valuable to have guidance on who should be tested and recommendations regarding delivery, such as avoiding internal fetal monitoring, prolonged rupture of membranes, and episiotomy in laboring patients.”
In addition to Kuller, the publication was authored by Duke MFM infectious disease expert Brenna Hughes, MD, MSc, and Duke OBGYN resident Charlotte Page, MD, in conjunction with the society for SMFM Publications Committee.