Hepatitis C during pregnancy

By trimester

Weeks 1–13

1st trimester

CDC recommends hepatitis C screening during each pregnancy. A reactive HCV antibody can reflect current, past, or resolved infection, so reflex nucleic acid testing for HCV RNA is the step that identifies current infection.

Weeks 14–27

2nd trimester

Current infection calls for linkage to hepatitis care, review of liver health, and screening for relevant coinfections. Direct-acting antiviral data in pregnancy remain limited, so medication timing is a specialist decision rather than a reason to stop or start a regimen independently.

Weeks 28–birth

3rd trimester

Hepatitis C alone is not an indication for cesarean birth. SMFM advises limiting internal fetal monitoring and early artificial membrane rupture when they are not otherwise necessary, and the infant's testing plan should be documented before discharge.

What does the evidence show for hepatitis C?

• CDC recommends starting with an HCV antibody test and automatically performing a nucleic acid test for HCV RNA when the antibody is reactive; an antibody alone does not establish current infection, and no vaccine is available for hepatitis C. 1
• SMFM recommends HCV antibody screening in every pregnancy, advises that direct-acting antivirals be initiated during pregnancy only within a clinical trial, and calls for shared decision-making if pregnancy begins during an antiviral course. 2
• Hepatitis C can pass to the fetus only when the pregnant person has current infection; published outcomes are variable, and an individual transmission outcome cannot be predicted from the antibody result alone. 3
• SMFM recommends against cesarean birth solely because of hepatitis C and advises avoiding internal fetal monitors and early artificial rupture of membranes unless obstetrically necessary; standard breastfeeding guidance applies unless nipples are cracked or bleeding. 2
• CDC recommends an HCV RNA nucleic acid test at age two through six months for every perinatally exposed infant; a detectable result needs pediatric hepatitis expertise, while an undetectable result at or after two months usually needs no further follow-up. 4

When should I call my provider about hepatitis C?

Contact your pregnancy or hepatitis team promptly for yellowing of the skin or eyes, dark urine, clay-colored stool, fever, or new abdominal pain. Seek urgent care if abdominal pain is severe, vomiting is repeated, you cannot keep fluids down, or you feel faint or acutely unwell. A positive HCV antibody without symptoms still needs RNA confirmation and follow-up. Whatever the pattern, any symptom that feels beyond your usual range is a reason to call: obstetric teams expect these questions and would rather hear early than late.