National Hepatitis C Testing Policy May 2007
Appendix 4 Antenatal testing
Factors not associated with a higher risk of transmission are the mode of delivery, hepatitis B co-infection and breastfeeding. At present no drug therapies can be recommended to reduce the risk of mother-to-child transmission. No specific intervention at the time of delivery has been shown to reduce the risk of transmission and breastfeeding has not been shown to increase the risk of HCV transmission to the baby.
There is no evidence that the prevalence of hepatitis C among pregnant women is significantly higher than for the general population. Routine screening of pregnant women is not a cost effective or clinically justifiable approach.
Any woman identified as being at risk of, or personally concerned about, HCV infection should be offered testing, including prior to undergoing any invasive medical procedures. The process of testing should follow the processes detailed in this policy.
Transmission from mother-to-child will not occur if the mother has spontaneously cleared the viral infection, so all pregnant women who test positive for anti-HCV antibodies should be offered qualitative HCV RNA testing to determine if they are still infectious. This indication for qualitative HCV RNA testing is covered under the Medicare Benefits Schedule (see Chapter 10).
Infants born to anti-HCV positive mothers will have passively acquired antibodies. In uninfected infants, seroreversion or loss of maternal antibodies will be seen within 18 months. Antibody testing should therefore only be carried out after the child reaches 18 months of age.
This section of the National Hepatitis C Testing Policy will be regularly reviewed, to take account of any therapeutic advances that could minimise the risk of transmission and other new information, including information on hepatitis C sero-prevalence.