Optimizing Care for Reproductive-Age Women with Hepatitis C Virus

Background: Hepatitis C virus (HCV) infection affects between 1% and 2.5% of pregnant people in the United States and has maternal and fetal sequelae. Direct-acting antivirals are a highly effective curative strategy for HCV, yet data on their use in pregnancy are limited. Thus, family planning counseling of pregnancy-capable people seeking treatment for HCV is imperative. We aimed to examine whether and how pregnancy-capable people with HCV received family planning counseling from their clinicians during their treatment of HCV. Methods: This retrospective cohort study included all female patients between 18 and 50 years of age with HCV who sought care at a large, multihospital medical system between 2016 and 2020. Outcomes included whether patients who sought care for HCV received family planning or preconception counseling and the type of counseling they received. Analysis was conducted using descriptive statistics. Results: In this analysis of 194 people meeting inclusion criteria, 146 sought treatment for HCV, of whom 16 were currently pregnant. Of those seeking treatment, 24% discussed the uncertainty of treatment safety during pregnancy with their clinician, 23% received contraceptive counseling, 7% received preconception counseling, and 10% discussed family planning goals. Of the participants who were pregnant, 74% discussed the risks of treatment during pregnancy, and 67% had a postpartum treatment plan. Conclusions: In this cohort of pregnancy-capable people with HCV, patients infrequently received counseling about reproductive planning before or during their HCV treatment. Although most patients who were pregnant received counseling on treatment recommendations, few were referred to maternal-fetal medicine subspecialists.