Hepatitis C 101: HCV and Pregnancy – Health of the mother to be

If you have tested positive for the hepatitis C virus (HCV) and become pregnant, a comprehensive assessment will be administered by your physician that looks at your overall health, the health of your liver, and any additional risk factors during your pregnancy. This assessment will help your physician determine whether a multi-disciplinary team approach will be beneficial to your pregnancy and what your prenatal care plan should entail. Your prenatal care plan then determines how your physician will monitor your pregnancy and any special considerations to include or exclude from your treatment, including immunizations.

Specific Tests for HCV-Positive Pregnant Women

The health of your liver is a key factor in determining the health of your pregnancy when you are positive for HCV and therefor, will be monitored to detect any increases or decreases in liver enzymes, proteins, clotting agents, and other relevant factors. Monitoring these areas helps detect inflammation of your liver or other complications as they arise and before they become major concerns. Liver function tests should be measured each trimester and will be compared to baseline values established during your initial assessment and testing with your physician.^1,2,3,4 Using your baseline values as a point of reference will help your physician distinguish between HCV-related liver dysfunction and that from pregnancy-induced complications, such as cholestasis of pregnancy.

In addition to routine prenatal laboratory tests, the following specific liver function and hepatitis tests will likely be requested by your physician in early pregnancy and then again at recommended intervals throughout your pregnancy – often, each trimester:

• Aminotransferases – measuring the ALT and AST enzymes that are found mainly in the liver.
• Albumin - measuring a protein made by the liver.
• Bilirubin – measuring the yellowish pigment found in bile, a fluid made by the liver.
• INR - measuring how long it takes blood to clot.
• Anti-HBs – measuring HBV antigens.
• Anti-HA total or IgG – measuring HAV antibodied.
• HCV RNA qualitative test – measuring HCV viral load.

Immunizing HCV-Positive Pregnant Women for Hepatitis A & B

As part of your prenatal care plan, your physician may suggest immunizations to protect your liver from further damage, because an HCV infection poses a significant risk of progressive liver diseases, and vaccinating against other hepatitis viruses can help eliminate the chance of acquiring a superinfection (an infection that occurs after or alongside another infection) with hepatitis A and/or B. Both the hepatitis A and B virus immunizations can be administered during pregnancy, and these immunizations can reduce the threat to patients with a chronic HCV infection from developing severe or sudden liver failure due to a superinfection with hepatitis A or B.

Can I be treated for hepatitis C while I'm pregnant?

Whether you will be able to begin or continue treatment while pregnant depends on the treatment you’ve been prescribed and the status of your infection as determined by your physician from your initial assessment and testing.

If you are being treated with a combination of medication that includes ribavirin, you will have to cease treatment immediately, as ribavirin is classified as a category X drug by the Food and Drug Administration (FDA). A category X classification means the drug is not safe to take during pregnancy, because it could cause serious birth defects or even death to the unborn child.

However, not everyone with HCV starts treatment right away, and if you do need it, you can talk to your physician about choosing one of the newer regimens that have been given a category B classification or starting treatment after your baby is born.

Pregnancy Category B Medications

The FDA uses a category system to classify the potential risks to an unborn child when a specific medicine is taken during pregnancy. Pregnancy Category B is given to medicines that have not been adequately studied in pregnant humans but have not appeared to cause harm to the fetus during animal studies. Medications that have been shown to be safe for use in pregnancy in humans but have caused problems in laboratory animals are also given a Category B rating.

Some of the newer treatments for HCV: Boceprevir (Victrelis), Simeprevir (Olysio), and Sofosbuvir (Sovaldi) have not been adequately studied in pregnant humans. In animal studies, they did not cause birth defects or other problems when given to pregnant rats and rabbits, so by themselves, they are labeled category B. However, because they are almost always given in combination with ribavirin, which is a pregnancy Category X medicine, they should not be used in pregnant women.^1,2,3,4

Harvoni & Viekira Pak

There are also no adequate or well-controlled studies in pregnant women with the newest two treatment options, Harvoni and Viekira Pak, so they have also been categorized by the FDA as B-level drugs. Because animal reproduction studies are not always predictive of human response, Harvoni and Viekira Pak should only be considered during pregnancy if clearly needed and if the potential benefit justifies the potential risk to the fetus.^1,2,3,4

It is also unknown if any of the drugs in Harvoni and Viekira Pak pass into breast milk, so consult your doctor before breastfeeding as well.

How will having hepatitis C affect my pregnancy?

Women with HCV and their unborn babies are at little to no greater risk of obstetric or perinatal complications compared with other women. So far, research has shown that there is no solid indicator that HCV increases complications during pregnancy on the grounds of HCV alone.