Through pregnancy, it is routine to monitor LFT results at each antenatal clinic appointment as a marker for potential obstetric complications (HELLP, pre-eclampsia, acute fatty liver, etc.), particularly in the final trimester. Where there is a suspicion that acute hepatitis C may be presenting during pregnancy, it is important to monitor the HCV VL through pregnancy at 4-weekly intervals. In chronically infected patients there is unlikely to have been significant change in the HCV VL. However, the prenatal VL will give some idea as to the risk of MTCT and may be worth repeating near delivery. INNO-406 molecular weight If pregnancy has occurred during treatment for HCV with pegylated interferon

and ribavirin, in addition to immediate discontinuation of treatment, thyroid function test should be included in the routine bloods as thyroid dysfunction occurs in approximately 7% of patients. Finally, it is recognized that a small number of coinfected patients are HCV antibody negative but HCV viraemic. Where there is evidence of liver inflammation or fibrosis, profound immune deficiency, or risk factors, an HCV VL assay should be performed. 6.2.3 Coinfected mothers with HCV should not be treated for HCV with pegylated interferon with or without

ribavirin and all women who see more discover they are pregnant while receiving treatment should discontinue both pegylated interferon and ribavirin immediately. Grading: 1B There is no evidence that HCV can be transmitted vertically in the absence of HCV viraemia so only viraemic patients would be considered for therapy. The current standard of care in HCV therapy is the combination of pegylated interferon and ribavirin with the addition of either telaprevir or boceprevir for genotype 1. There are no definitive studies on the safety of HCV

antiviral therapy during pregnancy. However, pegylated interferons are abortifacient at Oxalosuccinic acid high doses in monkeys and when given in the first trimester have been associated with an increased risk of fetal loss and low birthweight in humans. Ribavirin has been assigned to category X by the FDA and is not recommended for use in pregnancy. Significant teratogenic and/or embryocidal effects have been demonstrated in all animal species exposed to ribavirin. It is contraindicated in pregnancy and in male partners of women who are pregnant. Hence, active treatment during pregnancy can only be considered once directly acting antiviral agents have been shown to be safe and effective in combinations without pegylated interferon and ribavirin. In the Ribavirin Registry, 6.1% of women who received ribavirin at some point during their pregnancy had offspring with birth defects [34]. Given the evidence from animal data, women with coinfection should discontinue HCV therapy as soon as pregnancy is confirmed.