Table 1.
Pregnancy Features That May Impact Perinatal Transmission of HCV During Pregnancy and Postdeliverya
| Pregnancy Considerations | Studies; # of Women | Number of Women | Strength of Evidence | Summary of Findings | SMFM Recommendation |
|---|---|---|---|---|---|
| Elective C‐section versus vaginal delivery | 4 cohort studies30, 54, 55, 56 | 2,080 | Low | No differences, but trends in opposite directions in highest‐quality studies | Do not recommend C‐section solely for indication of HCV |
| All C‐section versus vaginal delivery | 11 cohort studies24, 27, 31, 57, 58, 59, 60, 61, 62, 63, 64 | 2,308 | Moderate | No association | |
| Amniocentesis and CVS | 3 cohort studies30, 54, 56 | 928 | Insufficient | Inconsistent, but one good quality study (OR, 6.7; 95% CI, 1.1‐36.0) | Counsel patients on potential risks of amniocentesis and CVS |
| Prolonged ROM | 2 cohort studies30, 31 | 245 | Low | Yes with >6 hours (OR, 9.3; 95% CI, 1.5‐1.8) | Active labor management if prolonged ROM to expedite delivery |
| Breastfeeding | 15 cohort studies24, 27, 30, 31, 54, 55, 59, 62, 63, 64, 65, 66, 67, 68, 69 | 2,971 | Moderate | No association between breastfeeding and risk for transmission | Do not discourage breastfeeding based on positive HCV status |
a
Adapted from Cottrell et al.29
Abbreviations: C‐section, cesarean section; CVS, chorionic villus sampling; ROM, rupture of membranes.