Differing presentations of hepatitis C in pregnancy: A case report series supporting universal screening for hepatitis C virus in pregnancy

The prevalence of Hepatitis C virus (HCV) infection in women of childbearing age is on the rise. Of people infected, 50–85% develop chronic hepatitis C. Chronic HCV infection is significant because it puts the mother and fetus at risk for well described complications. Conversely, pregnancy alters the natural progression of chronic HCV potentially impacting the long-term health of the mother. Differing presentations of HCV make the identification of patients with HCV infection challenging. Currently, HCV testing for pregnant women is only recommended by the Society for Maternal Fetal Medicine (SMFM) and the American College of Obstetrics and Gynecology (ACOG) for women with preexisting risk factors. Case Series: In this case series of three obstetric patients with HCV we would like to highlight the varied range of clinical presentations of HCV in pregnancy. The first patient had a known HCV infection prior to pregnancy. Liver function tests and a viral load collected at her first prenatal visit were consistent with viral clearance and she went on to have an uneventful pregnancy. Patient two developed intrahepatic cholestasis of pregnancy (ICP), a well-described complication of chronic HCV infection. Finally, patient three developed transaminitis and a decrease in her viral load: the opposite of expected findings. Conclusion: This case series illustrates classic and unusual presentations of HCV in pregnancy. Heterogeneity of presentations with inconsistent presence of risk factors on presentation makes predicting who needs screening difficult. Given the availability of new treatments and the serious morbidity chronic hepatitis can inflict on both the mother and baby perhaps universal HCV screening in pregnancy should be reconsidered.