Prenatal hepatitis C screening can spare women and babies from long-term liver damage
August 31, 2021
In April 2020, the Centers for Disease Control and Prevention (CDC) began recommending routine prenatal screening for hepatitis C, a liver-damaging virus that can be passed to the fetus during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) began recommending the same in May 2021.
Approximately 1-2% of U.S. adults have hepatitis C. According to the CDC, rates of new hepatitis C infections increased by more than 60% from 2015 to 2019. More than half of new cases in 2019 were diagnosed in adults ages 20-29 – the prime reproductive years.
According to ACOG, approximately 6% of babies born to mothers with hepatitis C are infected during pregnancy and delivery. While many infants clear the virus naturally by age 2, 20-25% may develop cirrhosis of the liver by age 8.
Unfortunately, hepatitis C – also called “hep C” – bears a stigma because it is spread through contact with infected blood. Patients may be infected during contact with unsterile needles from piercing or tattooing, needle-based drug use, unprotected sex, or receipt of a blood transfusion prior to 1992, when more stringent donor testing was implemented.
That last risk hits home. My daughters were born in 1991 and had to stay in the neonatal intensive care unit (NICU) where they received blood transfusions, putting them at higher risk.
Even if you feel these risk factors don’t apply to you today, it’s possible to have contracted the disease in the past without knowing it. Many patients with hepatitis C do not have symptoms; those who do may experience vague symptoms such as these within 6-12 weeks after infection:
- Poor appetite
- Sore throat
- Joint pain
Fortunately, more than 90% of adults with hepatitis C can be cured with 8-12 weeks of oral antiviral medication. However, without medical care, the disease may progress into chronic hepatitis C, which can cause cirrhosis of the liver (scarring of the liver tissue), liver failure, and liver cancer.
The goals of routine hepatitis C screening are twofold: to present women with judgment-free treatment options to pursue after delivery and to plan for proper screening and potential treatment of the baby, reducing the child’s risk of long-term liver damage.
How does hepatitis C screening work?
A simple blood draw can tell us whether you have hepatitis C antibodies, which indicate a past infection. Patients whose past infections were successfully eradicated – either through treatment or by their body’s own immune system – are at very low risk of passing the virus to the baby after delivery.
The screening also detects bits of the hepatitis C virus in the blood, which can indicate a chronic infection. Patients with chronic hepatitis C will always have the virus and will need treatment to manage it.
Related reading: Hepatitis C doesn't have to be a life sentence
What if I have chronic hepatitis C?
Talk with your doctor about the best strategies to protect your health and the baby’s long term. If you have liver disease, such as cirrhosis of the liver, you may be at increased risk of pregnancy complications such as preeclampsia or preterm birth.
To date, no treatment options for pregnant patients and children younger than 3 are approved by the U.S. Food and Drug Administration. This is because many antiviral drugs can increase the risk of pregnancy complications and/or birth defects.
After the baby arrives, you both might need specialized care, which may include:
- Getting you on medication to clear the infection and manage or prevent liver damage
- Screening or testing of the baby in the year after delivery
- Planning for treatment in early childhood if the baby is infected and does not clear the infection naturally by age 2
What if I test positive for hepatitis C during pregnancy?
If you are diagnosed during pregnancy, know that there are safe, effective treatments you can get after your baby is born. Depending on the severity of your condition, you might need oral antiviral medication for eight to 12 weeks or a combination of pills and injections for 12-48 weeks to slow or stop the virus.
Although blood contact is the main transmission method of hepatitis C, the risk of the baby being infected during labor and delivery is low. Discuss with your doctor strategies that may reduce the risk of transmission.
However, there is no need to plan for a cesarean section (C-section) solely because a patient is infected. Women with hepatitis C also do not have to avoid breastfeeding unless their nipples are cracked or bleeding.
Will my baby need special testing if I have hepatitis C?
Testing the baby right after delivery will not provide a definitive “yes” or “no” about whether the baby is or will be infected. Though the risk is low, it is possible for the mother’s hepatitis C antibodies to appear in the baby’s blood for up to 18 months, even if the child itself is not infected.[MO2]
Current infant screening guidelines from the American Association for the Study of Liver Diseases and the CDC recommend that all babies born to women with hepatitis C get tested for antibodies at 18 months of age, and those who have antibodies should get tested after age 3 to confirm or rule out chronic infection.
While newborns get their first of three vaccinations against hepatitis B within 24 hours after birth, there is no vaccine against hepatitis C. Getting treatment after delivery for yourself and in early childhood for your baby can prevent years of potential liver damage by the hepatitis C virus.
Though it can be scary and overwhelming to talk with a doctor about hepatitis C, please know that our goal is to give you and your baby the very best care – now and in the long term.