Skip to Main Content
Skip Nav Destination

Guidance on HCV screening in pregnant women important for prevention of chronic infection in children

February 26, 2021











Pediatricians have a new tool in their fight against hepatitis C virus (HCV) infection in children: the obstetrical record. The Centers for Disease Control and Prevention, the U.S. Preventive Services Task Force and the American Association for the Study of Liver Diseases recommend that allpregnant women be screened for HCV.

The new recommendation is in response to the alarming increase in chronic HCV infections in 20- to 39-year-olds, thought to be driven by needle-sharing in the ongoing opioid epidemic. Identifying HCV-infected individuals early allows for treatment with highly effective antiviral therapies and raises the hope of reducing HCV’s tremendous national and global disease burden.

Screening is by detection of HCV antibody, followed by polymerase chain reaction testing of blood in individuals who are antibody-positive to identify those with chronic HCV infection.

Pregnant women who are HCV-infected risk transmitting the virus to their newborn at the time of delivery. Risk of perinatal transmission averages 5% to 6%, and transmission is associated with presence of HCV viremia at or near the time of delivery. Transmission rates are higher when mothers are infected concurrently with HIV. Transmission is not increased with breastfeeding or with vaginal delivery compared with cesarean delivery.

Approximately 80% of newborns infected by maternal transmission are unable to clear the virus, placing them at risk for chronic HCV infection. Though most children with chronic HCV are asymptomatic, liver damage can occur. As a result, they are at risk for serious sequelae of HCV infection, including cirrhosis, liver cancer and the eventual need for liver transplantation.

With the new recommendations to screen for HCV during pregnancy, pediatricians can review the obstetrical record to identify newborns at risk for vertical transmission. Per the upcoming 2021 edition of the AAP Red Book, testing for perinatally acquired HCV infection relies on serologic testing at 18 months of age. When there is concern about long-term follow-up of an infant exposed to HCV perinatally, or when a family is not willing to wait until 18 months of age to determine the child’s HCV infection status, nucleic acid amplification testing (NAAT) for HCV RNA detection can be performed between 2 and 6 months of age. Regardless of the NAAT result, serologic testing should be performed at 18 months of age for a more definitive diagnosis.

Part of the reason the universal screening strategy for pregnant women is an important change is that several antiviral therapies that cure HCV infection have been approved down to 3 years of age. Knowing which children are at risk of perinatal acquisition of HCV allows testing and referral to pediatric gastroenterology or infectious disease specialists prior to the child’s third birthday. This approach can eliminate the possibility of developing serious liver disease later in childhood or in adulthood.

One challenge involves information exchange, since pediatricians must act on results obtained more than 18 months earlier during the mother’s pregnancy. One strategy may involve checking the obstetrical record of all newborns presenting for well-child care. If indicated, an alert to test at 18 months can be placed in the chart. In addition, pediatricians may establish a practice of reviewing the obstetrical record at the 18 month well-child visit. With the near-complete adoption of electronic medical records, pediatricians may identify other creative solutions to ensure that HCV information from the obstetrical record is obtained and used to identify and ultimately cure infants with chronic HCV from vertical transmission. 

Universally testing all young children may be even simpler, and cost-effectiveness studies suggest this strategy warrants national discussion.

Dr. Harpavat is a member of the AAP Section on Gastroenterology, Hepatology and Nutrition Executive Committee. Dr. Kimberlin is an ex officio member of the AAP Committee on Infectious Diseases and the 2021 Red Book editor. 

Close Modal

or Create an Account

Close Modal
Close Modal