New treatment guidelines convey a startling reality: hepatitis C isn’t only a baby boomer problem anymore. Spurred by the opioid epidemic and a national spike in heroin use, the disease poses a growing threat to young people. That includes women of childbearing age. The trend has led experts at the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America to turn their attention to this vulnerable population.
“Women of reproductive age with [hepatitis C] should be counseled about the benefit of antiviral treatment prior to pregnancy,” the organizations explain. Direct-acting antiviral cures have a success rate of greater than 90 percent, but the drugs have not been proven safe for pregnant women.
Getting treatment before pregnancy is critical. But it may prove difficult.
Given the high cost of hepatitis C cures, Medicaid and other health plans often restrict their use. Some plans stipulate that only a medical specialist can prescribe curative treatment for hepatitis C. Seeing these specialists can require long wait periods or demand that patients in rural areas travel for an appointment. Plans may also impose a multistep pre-approval process known as “prior authorization” before they agree to cover treatment.
These hurdles may pose problems for women and their unborn children. Hepatitis C can pass from mother to unborn child, with no means to prevent transmission. The guidelines note that pregnant women with hepatitis C may have a higher risk for congenital abnormalities or preterm birth. Women whose infection has progressed to cirrhosis of the liver risk preeclampsia and C-section, as well as preterm delivery or a low birth-weight baby.
The guidelines stop short of recommending universal hepatitis C screening for pregnant women, though the option is under consideration. The group does encourage screening of women with known risk factors, such as HIV infection or injected drug use.
For more on barriers to hepatitis C treatment, read, “Improving Patient Access to Hepatitis C Cures.”