Breaking the Cycle: How Universal Screening and Same-Day Treatment Can Eliminate Perinatal Hepatitis C

Published Oct 8, 2026

Hepatitis C is one of the few chronic viral infections we can now cure outright — yet it still passes from mother to baby in thousands of pregnancies each year, often because treatment gets lost in the shuffle of postpartum life. Dr. Laura Marks and Dr. Madeline McCrary are two of the nation’s few physicians dually trained in infectious diseases and addiction medicine. In this blog, they outline why screening matters, how treatment actually works and what Missouri hospitals can do right now to close the gap.

Meet the Experts

Dr. Marks and Dr. McCrary are board certified in internal medicine, infectious diseases and addiction medicine at Washington University School of Medicine in St. Louis. Their work sits at the intersection of substance use care and infectious disease treatment, and — through a partnership with WashU’s OB and Maternal-Fetal Medicine teams — they’ve built some of the region’s most effective programs for treating hepatitis C during pregnancy and the postpartum period.

What Is Hepatitis C and Why Does It Matter in Pregnancy?

Hepatitis C virus is a blood-borne infection that primarily damages the liver over time, potentially leading to cirrhosis, liver cancer, liver failure or death. Because most people have no symptoms, many don’t even know they’re infected — which is exactly why screening is so critical.

HCV spreads through contact with infected blood, most commonly via shared drug-use equipment or unregulated tattoos and piercings, and rarely through sexual contact. It also can pass from mother to baby during pregnancy, occurring in about 8% of exposed pregnancies. Additionally, HCV infection in pregnancy is linked to cholestasis, a liver condition associated with preterm delivery and stillbirth.

One reassuring note: HCV is not spread through breastmilk, though there’s a very small transmission risk if a mother’s nipples are cracked or bleeding.

Why Universal Screening — and Why Treat at Delivery?

The Centers for Disease Control and Prevention, U.S. Preventive Services Task Force, and major national societies now recommend universal HCV screening for all adults, including early in and during every pregnancy. This matters for two reasons: HCV is curable, and infants exposed to HCV need to be tested between 2 and 6 months of age and connected to care if infected.

Here’s the catch: fewer than 6% of women with HCV during pregnancy access curative treatment in the postpartum period. Life after delivery is full of competing demands, and many people never even make it to their own postpartum visit — let alone a separate HCV treatment appointment. Too often, these patients aren’t identified again until their next pregnancy.

That’s why treating HCV at the time of labor and delivery is so powerful. Patients are already in the health care system, already engaged — so offering curative medication during that admission removes the postpartum-visit barrier entirely and can break the generational cycle of perinatal HCV.

Treatment: Safe, Simple and Increasingly Accessible

Two front-line medications lead HCV treatment today:

• Sofosbuvir/velpatasvir (Epclusa)
• Glecaprevir/pibrentasvir (Mavyret)

Both are safe, well tolerated and cure more than 95% of patients with an eight- to 12 -week course of pills. These same medications treat infected children once they turn 3.

A few practical notes for providers and patients:

• Cost and access: Missouri Medicaid covers glecaprevir/pibrentasvir at no cost, with no prior authorization — and the full eight-week course can be dispensed up front, with no refill required.
• Drug interactions: Clinically significant interactions are uncommon. The most notable is between sofosbuvir/velpatasvir and stomach-acid medications.
• Food and adherence: Glecaprevir/pibrentasvir works best with food, but food insecurity shouldn’t be a barrier — getting the medication into a patient’s hands matters more than perfect conditions.
• Tolerability: Most patients experience little more than mild stomach upset, fatigue or headache in the first few days, which typically resolves or responds to supportive care.
• Imperfect adherence is still worth it: Many patients are cured even with incomplete adherence, so adherence concerns shouldn’t be treated as a reason to withhold treatment.
• Substance use is not a contraindication: Active substance use should never disqualify a patient from HCV treatment.
• Confirming cure: Ideally, providers confirm cure with a follow-up HCV RNA test four-plus weeks after treatment ends — but even patients who miss that follow-up test are often cured. Access to medication is the priority.

A Blueprint for Other Hospitals: WashU’s Approach

WashU’s HCV program has evolved over time — starting as a telemedicine initiative, expanding to bring medication directly to the labor and delivery floor, and now including outreach during the second and third trimesters of pregnancy in addition to postpartum.

The central lesson: there are multiple windows to engage patients in HCV care, and no single window works for everyone.

• A patient seen in prenatal clinic can be set up for treatment before delivery so they can begin right after birth.
• A patient encountered during labor and delivery — especially one with limited or no prior prenatal care — can be treated during that admission itself.

For postpartum treatment, established simplified treatment algorithms from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America make the process straightforward once a team has done it a few times. The real challenge is care coordination — and a strong pharmacy partnership is essential, whether that’s an inpatient pharmacist who can route medication appropriately, a hospital pharmacy that stocks it or a community pharmacy willing to collaborate.

The Bottom Line for Missourians

Hepatitis C is curable with an eight- to 12-week course of pills that are safe, well tolerated and free under Missouri Medicaid. Treating it protects not just the patient, but their family, community and future pregnancies.

Dr. Marks and Dr. McCrary’s message is simple: get screened, get treated — there’s no downside. And for mothers who want to breastfeed while undergoing treatment, current evidence suggests it’s likely safe to do both.