By Dr. Ram Prakash, Maaeri Fertility & IVF Centre Hepatitis C screening during pregnancy is one of the most consequential routine checks in antenatal care — and one of the most underutilised. Globally, more than 71 million people live with chronic hepatitis C, with 40% in the reproductive age group, and nearly half of infected women are unaware of their status. Identifying HCV infection during pregnancy creates a window to protect mother and baby at a time when women are highly engaged with healthcare — an opportunity that, if missed, may not recur for years.
Why Is Hepatitis C Screening Recommended During Every Pregnancy?
The Society for Maternal-Fetal Medicine updated its guidelines to recommend universal HCV screening during each pregnancy, moving away from a risk-factor-only approach. The reason is straightforward: restricting screening to high-risk groups misses a substantial proportion of infections. At Maaeri, we adopted universal HCV screening as part of our standard antenatal panel for exactly this reason — universal screening in one real-world implementation saw detection rates rise from 5.78% to 77.25%, identifying cases that would otherwise have gone undetected and untreated.
What Happens If Hepatitis C Is Not Detected During Pregnancy?
The primary concern is vertical transmission — the passing of HCV from mother to infant during pregnancy or delivery. The rates of vertical transmission are:
5.8% in HCV-positive women without HIV co-infection
around 10.8% in women who also have HIV, where a higher viral load raises the risk Vertical transmission is now the leading cause of HCV in children. In adults the infection often stays quiet for decades before it damages the liver. In children it runs differently. A child infected with HCV carries a lifelong risk of chronic hepatitis, and later cirrhosis or liver cancer. The risk is closely tied to the mother's viral load at delivery. Mothers with undetectable HCV-RNA rarely pass it on. Early detection matters for this reason. HCV in pregnancy carries other risks too. Preterm birth. Low birth weight. Obstetric cholestasis. A higher chance the newborn needs neonatal intensive care.
How Is Hepatitis C Treated in the Context of Pregnancy?
Current Treatment Landscape
Direct-acting antivirals, or DAAs, changed HCV treatment. Cure rates run above 95% in eligible patients. Their safety in pregnancy is still being worked out. For now the guidelines do not routinely start DAA treatment during the pregnancy itself. What usually happens instead is this.
Screening picks up the infection during the pregnancy.
Liver function and viral load are watched through the rest of it.
DAA treatment usually waits until after delivery, once feeding decisions are settled.
The baby is screened at 18 months, though molecular testing can be done as early as 2 months. There are really two goals here. Curing the mother. And keeping the baby clear of the virus. Both are possible when the infection is caught early. Treatment after delivery still lowers the mother's risk later on, and it shapes how the baby is monitored.
What Screening Does Not Affect
The mode of delivery does not change transmission. Vaginal or caesarean, neither has been shown to lower vertical transmission of HCV. So HCV status on its own does not change delivery planning. Breastfeeding is not ruled out either, as long as the nipples are not cracked or bleeding. Hepatitis C screening in pregnancy is a small blood test. It carries a lot of weight for the mother and the baby. Catching it early is what opens up treatment and proper monitoring. It also prevents a transmission that could have been avoided. At Maaeri it is a routine part of antenatal care. It is worth asking your doctor about at the first prenatal visit.
