It has been found that in patients with HCV infection combined with pregnancy, HCV can directly infect placental cells, which in turn can be transfected to the fetus, leading to mother-to-child transmission of HCV (Figure 1). Studies have shown that the risk of HCV transmission from an anti-HCV-positive mother to her newborn is 2%, and if the mother is positive for HCV RNA at the time of delivery, the risk of transmission can be as high as 4% to 7%; the risk of transmission increases to 20% with co-infection with HIV. Mother-to-child transmission is the main route of transmission in HCV endemic areas, and maternal HCV viral load and overlap infection with HIV are important influencing factors for infant HCV infection; while another study found that HCV did not increase the occurrence of adverse events during pregnancy. Therefore, effective antiviral therapy for pregnant HCV-infected patients can significantly reduce mother-to-child transmission. antiviral therapy for CHC is far more effective than chronic hepatitis B. Most CHC patients can be cured by antiviral therapy, and the earlier the treatment, the higher the SVR rate. Currently, clinically effective antiviral treatment for CHC is PEG IFN-α combined with RBV therapy. However, the use of IFN in pregnant women often causes miscarriage, and RBV may also affect fetal development and growth, so both IFN and RBV should not be used in women with CHC pregnancy. There is no safe and effective treatment for women with CHC pregnancy. Therefore, the fertility of women with CHC remains a challenge for clinicians. Combining clinical and related research advances, patients with CHC combined with pregnancy can be managed accordingly in four stages: before pregnancy, during pregnancy, during delivery and after delivery: ① HCV infection before pregnancy is not a contraindication to pregnancy. Women with high-risk factors for HCV infection (e.g., intravenous drug use, blood or blood product transfusion) should be tested for anti-HCV status prior to pregnancy. Research evidence suggests that a high maternal viral load is a risk factor for vertical transmission from mother to child. If HCV infection is detected before pregnancy and HCV RNA is positive, anti-HCV treatment with IFN in combination with RBV should be used to effectively reduce viral load and prevent the occurrence of mother-to-child transmission of HCV, as well as to normalize transaminases and reduce the inflammatory response in the liver, making pregnancy safer. It is worth noting that contraception should be used during treatment and pregnancy should not be considered until 24 weeks after the end of treatment. IFN and RBV should be contraindicated in women during pregnancy. therefore, liver function should be closely monitored during pregnancy and no intervention should be made for those with normal liver function; for pregnant women with impaired liver function, other drugs such as hepatoprotective drugs that have no adverse effect on pregnant women should be given as appropriate for symptomatic treatment. There is no evidence that HCV infection causes preterm delivery or increases the incidence of complications related to fetal congenital anomalies, obstetric complications, or low birth weight children. The chance of mother-to-child transmission is about 4-7% in the presence of HCV viremia in the mother, and increases about 4-5 times in the presence of combined human immunodeficiency virus (HIV) infection. High maternal viral load, early fetal hypoxia, and exposure to virally contaminated maternal blood during delivery can increase the risk of vertical transmission of HCV. There is no unified view regarding elective gestational screening, choice of cesarean section, and the risk of breastfeeding. Current national and international studies suggest that avoidance of vaginal delivery and breastfeeding do not reduce the risk of vertical transmission of HCV. In 2011, the European Society of the Liver (EASL) also stated that cesarean section is not recommended to prevent vertical transmission of HCV in HCV-infected pregnant women during delivery, and that breastfeeding is allowed for CHC mothers as long as they are anti-HIV negative and not using intravenous drugs (B2). It is worth mentioning that for pregnant women with positive HCV RNA, amniocentesis should be avoided to minimize the duration of delivery, ensure the integrity of the placenta, and reduce the exposure of the newborn to maternal blood, thus reducing the chance of vertical transmission from mother to child. ④Mothers should receive anti-HCV treatment after delivery. However, there is no effective vaccine available for infants delivered by HCV RNA-positive mothers. To determine whether the infant has acquired vertical HCV infection, physicians should perform one HCV RNA polymerase chain reaction (PCR) test 1 month after birth and one at 6 months after birth, and those with positive results on both tests are diagnosed with HCV infection and should be followed up. Infants with negative test results may be tested for anti-HCV at 12 months of age, and if positive, they should be tested again at 18 months of age. Studies have shown that those who are positive for HCV RNA in the neonatal period can turn negative in infancy, suggesting that postnatal viremia may be transient. The Royal College Child Health Centre recommends that PCR testing for HCV RNA be performed at birth and once at 6 months, 18 months, and 24 months after birth, respectively, and that children diagnosed with persistent HCV infection should receive long-term follow-up to determine the need for treatment. It is generally accepted that IFN and RBV therapy should not be used in children under 3 years of age.