NICU

Perinatal Hepatitis C Exposure

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Perinatal Hepatitis C Exposure, Infants born to Mothers with Hepatitis C, HCV Vertical Transmission

  • See Also
  1. HCV Infection
  • Epidemiology
  1. Prevalence of Hepatitis C Virus Prevalence in pregnancy has increased dramatically since 2000 in the United States
  • Indications
  • Screening Pregnancy
  1. See Hepatitis C for risk factors
  2. Universal Screening for all U.S. pregnant women in early prenatal period (per CDC)
  • Pathophysiology
  1. Vertical transmission Risk
    1. Mother HCV Ab positive and HCV RNA negative: 1.7% vertical transmission rate of HCV
    2. Mother HCV Ab Positive and HCV RNA positive: 4.3% vertical transmission rate of HCV
    3. Mother HCV Ab Positive and Comorbid HIV positive: 19.4% vertical transmission rate of HCV
  2. Factors that do not impact transmission
    1. Ceserean section does not reduce transmission
    2. Breast Feeding does not increase transmission rate
  1. Initial False Positive testing due to persists maternal HCV antibodies in infant for upwards of one year
  2. Obtain initial HCV RNA NAT (Nucleic Acid Test) at 2 to 6 months in all infants exposed to HCV positive mothers
    1. Catch up testing for all infants 7 to 17 months who have not yet been tested
  3. Interpretation
    1. Negative HCV RNA NAT
      1. Single NAT test at 2 to 6 months is sufficiently accurate to exclude HCV Infection in infants
    2. Positive HCV RNA NAT
      1. See Management below
      2. Two samples are no longer required
  • Management
  • HCV Positive infant
  1. Refer to pediatric specialists in HCV Infection
  2. Spontaneous clearance without treatment occurs by age 5 years in 20 to 40% of HCV perinatally infected infants
  3. Some HCV Antivirals are approved for age 3 years old and older
  4. Monitor Alanine transaminase and markers of Hepatic Fibrosis
    1. HCV complications are typically delayed for decades
    2. However, advanced fibrosis and Cirrhosis has occurred in HCV positive teens with perinatal acquired HCV
  • Management
  • HCV positive mother
  1. Gastroenterology or infectious disease referral for Hepatitis C infected mother
  2. Most Antiviral treatment is contraindicated in pregnancy
    1. Includes the older Interferon and Ribavirin protocol contraindicated in pregnancy (Ribavirin is Teratogenic)
  • References
  1. Airoldi (2006) Obstet Gynecol Surv 61(10): 666-72 [PubMed]
  2. Ades (2023) Clin Infect Dis 76(5): 913-91 [PubMed]
  3. Chappell (2018) Pediatrics 141(6): e20173273 [PubMed]
  4. Panagiotakopoulos (2023) MMWR Recomm Rep 72(4):1-21 +PMID: 37906518 [PubMed]