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Hepatitis C in Women: Updated Guidance on Screening and Management

Tatyana Kushner, MD, MSCE
Released: December 1, 2020

Effects of HCV on Pregnancy

What Is the Effect of HCV Infection on Pregnancy?

What are the possible adverse outcomes of HCV on pregnancy and fetal growth? It is important to recognize that, although large studies have attempted to analyze this, it is difficult to distinguish the effect of the HCV infection itself from the coexisting risk factors for adverse pregnancy outcomes (such as injection-drug use), which are common among women with HCV.

This slide shows data from a few studies evaluating the effects of HCV on pregnancy outcomes. The table on the left summarizes 2 reports from a large meta-analysis of 9 studies that compared > 5000 pregnant women with HCV with > 4 million pregnant women without HCV.[19,20] These reports identified an independent association between HCV and adverse pregnancy outcomes, including preterm birth, intrauterine fetal growth restriction, and low birth weight.

The table on the right shows the results of a large study from the Swedish Medical Birth Register assessing the possibility of an association between HCV and adverse outcomes.[21] This study, which included > 1 million women and > 2000 births to women with HCV, found an increased adjusted relative risk for preterm birth and late neonatal death with vs without HCV infection during pregnancy.

In the United States, there is an ongoing observational study assessing factors associated with vertical HCV transmission in pregnant women with HCV.[22] The primary endpoint of this study is HCV infection in the infant, with secondary outcomes of gestational age at delivery and adverse outcomes in the mother such as gestational diabetes, ICP, preeclampsia, and cholestasis. A description of the cohort of women included in the comparison groups (n = 251 HCV Ab-positive women vs n =131 women without HCV in the control group) has been published, but no data have yet been reported on the primary or secondary endpoints.[23]


By far, the most well documented adverse pregnancy outcome associated with HCV is ICP. This slide shows 2 studies that documented this association. A population-based cohort study in Sweden, which included 11,000 women with ICP matched with 11,000 women without ICP, showed a > 3-fold higher hazard ratio of ICP in women with HCV.[17]  

There was also a meta-analysis of 3 large studies evaluating rates of ICP in women with vs without HCV. In this meta-analysis, the pooled odds ratio of developing ICP in patients was 20 times greater in women with vs without HCV.[18]

Unfortunately, ICP is not an uncommon occurrence for pregnant women with HCV. Therefore, one of the key counseling points in women with HCV during pregnancy is about this condition and to emphasize its implications for fetal health. In severe cases, ICP can be associated with fetal demise. Therefore, it is very important to counsel women about symptoms of ICP and the urgency for them to report these symptoms so that treatment can begin at the earliest possible time.  

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