Curbing Mother-to-Child HCV Transmission: Norah Terrault, MD, MPH

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Addressing hepatitis C infections or potential infections during a woman’s pregnancy is an important part of preventive care against this virus.

At IDWeek 2026, held October 21 to 24, 2026, in Washington, DC, hepatitis C elimination was a popular topic. The session titled “Global Elimination of Hepatitis C in 2026” featured an array of clinicians specializing in hepatitis C care and prevention. Among them, Norah Terrault, MD, MPH, a professor of medicine and chief of the Division of Gastrointestinal and Liver Diseases at the Keck School of Medicine of the University of Southern California, and a panelist, discussed the nuances of treating pregnant women for hepatitis C and the preventive measures clinicians can take to reduce the risk of transmission from mother to child.

Guidelines from the American Association for the Study of Liver Diseases (AASLD), the Infectious Diseases Society of America, and obstetrics and gynecology organizations now recommend testing all pregnant women for hepatitis C with each pregnancy, recognizing that people can become infected between pregnancies, Terrault explained.

Should a woman be found to be viremic during pregnancy, clinicians can open the discussion about therapy with direct-acting antivirals.

“The drugs are not approved for use in pregnancy, but there is mounting evidence that they can be safely given, particularly in the third trimester,” Terrault said in an interview with The American Journal of Managed Care^®. “It’s something to discuss because by doing that, we’re taking advantage of a woman who’s in care and making sure that we’re dealing with hep C. But also if we treat the mothers, we can reduce the chance of mother-to-child transmission.”

Current guidelines call for identifying these women and treating them after they have delivered and finished breastfeeding, which Terrault called an “okay strategy,” though clinicians want to make sure these patients are not lost to follow-up.

Infants must also be tested, as there is a 5% chance of transmission from mother to child, Terrault said. The guidance for testing infants has also shifted in recent years to address this gap. Although the AASLD guidelines still recommend testing infants for hepatitis C antibodies 18 months after delivery, the recommendation has now shifted toward HCV RNA testing starting at 2 to 6 months, she said.

“And that aligns very well with where infants are getting vaccinations and other early care,” she explained. “So that’s a great opportunity for us to identify if the infant has become infected and then have a plan about how we’re going to try to take care of them going forward.”