Table 8.

Recommendations Addressing Screening, Treatment, and Monitoring of Pregnant Hepatitis C Virus-infected Women and Postpartum Issues

Recommendation	Rating
All pregnant women should be tested for HCV infection (see recommendations for initial HCV testing and follow-up), ideally at the initiation of prenatal care.	IIb, C
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
Treatment during pregnancy is not recommended due to the lack of safety and efficacy data.	IIb, C
HCV RNA and routine liver function tests are recommended at initiation of prenatal care for HCV-antibody–positive pregnant women to assess the risk of MTCT and degree of liver disease.	I, B
All pregnant women 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 women with pruritus or jaundice, there should be a high index of suspicion for intrahepatic cholestasis of pregnancy with subsequent assessment of alanine aminotransferase ALT, aspartate aminotransferase AST, and serum bile acids.	I, B
HCV-infected women 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
Breastfeeding is not contraindicated in women with HCV infection, except when the mother has cracked, damaged, or bleeding nipples or in the context of human immunodeficiency virus coinfection.	I, B
Women with HCV infection should have their HCV RNA reevaluated after delivery to assess for spontaneous clearance.	I, B

Abbreviations: HCV, hepatitis C virus; MTCT, mother-to-child transmission.