Prevention of HCV infection revolves primarily around exposure prevention through the use of safe handling of sharps and blood products. Barrier contraceptive use — particularly in those who are at high risk for blood exposure during sex, such as in men who have sex with men — can help reduce the risk for HCV transmission. Owing to the low risk for sexual transmission between monogamous, heterosexual couples in which one partner is infected with HCV, no specific guidance on barrier contraceptive use in this setting exists.
In the past, pegylated interferon alpha and ribavirin combination therapy was typically used to treat active HCV infection. More recently, DAA agents have replaced these drugs as they are easier to use, have a better safety profile, and are more effective. Several DAA regimens have been approved. Unfortunately, these agents have not been well studied in pregnancy and are not approved for use in pregnancy. The Society for Maternal-Fetal Medicine (SMFM) recommends that treatment for hepatitis C in pregnancy be reserved for clinical trial settings.
HCV has been associated with adverse outcomes such as preterm birth, low birth weight, and intrahepatic cholestasis of pregnancy. The risk for vertical transmission between an affected mother and her infant before or during delivery is approximately 5.8%; however, the risk is significantly higher in women who are coinfected with HIV. The mode of delivery does not seem to affect the risk for vertical transmission, and the SMFM does not recommend that HCV infection be used as the sole indication for cesarean delivery. Monitoring of hepatitis C during pregnancy is beyond the scope of this discussion, but serial liver function tests or viral load assessments are generally not recommended.
The patient in this case delivered a healthy infant at full term. Repeat hepatitis C RNA testing after the delivery was negative, which indicated a spontaneous clearance of infection. The infant was screened for hepatitis C RNA at 1 and 2 months of age, and both tests were negative.
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