Pregnancy and Breastfeeding with Hepatitis C: What You Need to Know

You can contract hepatitis C from exposure to blood. According to the Centers for Disease Control and Prevention (CDC), the two main ways are through intravenous (IV) drug use and being born to a mother with hepatitis C.

Although less likely, other ways the virus can be transmitted include:

• sharing personal items that may come into contact with blood, like razors and toothbrushes
• organ transplants
• sexual contact
• getting tattoos or piercings with nonsterile equipment

HCV infects the liver. This liver infection can lead to nausea and jaundice. However, you may have no symptoms at all. Your body may clear the virus on its own, although this is not common.

While the risk of transmission between mother and baby is generally low, hepatitis C may have an impact on a person’s ability to get and stay pregnant.

A 2017 study looked at women of childbearing age who were diagnosed with hepatitis C. The researchers found a direct link between having hepatitis C and premature ovarian decline.

In particular, the study found that women with hepatitis C had lower anti-Müllerian hormone (AMH) levels, which are used to determine a woman’s ovarian reserve (the amount of eggs that are available for pregnancy).

Overall, fertility was lower among women with HCV based on total fertility rate, or TFR. In this study, TFR was defined as the average number of children a woman would bear in her life.

The average fertility rate among women with hepatitis C was 0.7 compared to 1.37 in women without HCV.

Along with potentially making conception more difficult, pregnant people with hepatits C may have an increased chance for the following:

• excess weight gain during pregnancy
• gestational diabetes
• preeclampsia
• premature rupture of membranes

There’s not much research to explain potential links between pregnancy complications and being HCV-positive. In existing studies, the small sample sizes can make drawing reliable conclusions difficult for researchers.

Still, some research is beginning to point to a connection between HCV and increased incidence of gestational diabetes in pregnant women with HCV.

This is due to the effect of HCV on the pancreas, which may cause insulin resistance.

If someone has hepatitis C, there’s about a 5 percent chance of passing it to the child during pregnancy or birth. This risk rises to nearly 11 percent if they also have HIV.

Overall, the risk of transmission between mom and baby is relatively low, and specific situations also need to be present for this to happen. Specifically, a mother must have a higher viral load of HCV or also have HIV, as previously mentioned.

Does C-section vs. natural delivery make a difference?

You might wonder if a vaginal birth increases the risk of mother-to-child transmission of hepatitis C. Based on the research, that doesn’t appear to be the case.

In 2013, researchers looked at 18 studies conducted between 1947 and 2012 on how delivery methods relate to transmission of hepatitis C. They could not find a clear connection between delivery method and the risk of transmitting the virus.

The researchers did not recommend cesarean (C-section) delivery to avoid transmission. However, they do point out that a recommendation is difficult to make because the studies had small sample sizes and other drawbacks in their methods.

At this time, pregnant people with hepatitis C are not routinely advised to have a C-section unless there are other risk factors present, such as HIV coinfection. However, certain procedures are avoided in pregnant women with hepatitis C, such as invasive fetal monitoring during labor.

What is the impact of hepatits C on a baby?

While transmission can’t be prevented, there are signs that HCV can affect a baby’s health even during pregnancy.

Research suggests there’s a higher chance of certain issues in babies born to HCV-positive mothers, such as:

• low birth weight
• greater chance of preterm delivery
• jaundice
• intensive care unit hospitalization

Aside from screening for hepatitis C, there aren’t any treatments recommended during pregnancy.

If you have HCV and want to become pregnant, you should focus on first treating hepatitis C before becoming pregnant.

During pregnancy, the focus will be on receiving proper prenatal care — the same that would be recommended to someone without HCV.

Are hepatitis C drugs while pregnant safe for baby?

Again, it’s generally not recommended to give HCV medications during pregnancy as a precaution to prevent causing harm to the baby.

A multiyear study (from 2016 to 2018) suggests that certain HCV medications like ledipasvir and sofosbuvir can be safely prescribed during pregnancy to treat the condition without risk to the baby.

This was a small study and more research will be needed before general guidance is changed for HCV treatments during pregnancy.

Unless you attempt to enroll in a clinical trial specifically targeting HCV-positive pregnant women, most medical professionals will either tell you to complete treatment before getting pregnant or begin them immediately after giving birth.

If you’re a mother with hepatitis C, it’s acceptable to breastfeed your child, according to the CDC.

Researchers don’t believe the virus can be transmitted through breast milk. Some studies did not find higher rates of hepatitis C in breastfed infants than in formula-fed babies.

It’s not definitively known if breastfeeding with cracked or bleeding nipples can spread HCV, according to the CDC. However, hepatitis C can be transmitted through contact with HCV-positive blood, so the CDC advises against breastfeeding if you have cracked or bleeding nipples.

It’s suggested that mothers should discard their breast milk until nipples are completely healed.

Talk with your doctor about your breastfeeding plans. If you have HIV and hepatitis C, they can help guide you on how to do so safely.

If you believe you have hepatitis C, you may want to check with your doctor about getting a combination of blood tests.

The hepatitis C test is not routine during pregnancy. The test is normally only for people who fall in one of the higher risk categories.

If you test positive, baby will also need to be tested after birth.

Testing your baby

Between birth and 18 months, your baby will have acquired antibodies for hepatitis C from your body. This means an antibody test to determine if the virus is present won’t be reliable.

However, you can try a viral test when your child is between 3 and 18 months. The most reliable method for finding out if your child has hepatitis C is to have them tested after they turn 2 years old. They’ll be tested using a test that’s similar to the one used for adults.

The good news is that your child has up to a 40 percent chance of clearing the virus spontaneously by age 2. Some children even clear the virus on their own as late as 7 years old.

Hepatitis C is a virus that can impact your liver and is transmitted by exposure to blood.

Although acute cases tend to pass quickly and usually don’t create lingering effects, chronic HCV can cause liver damage, increase the risk of liver cancer, affect fertility, and cause complications during pregnancy that may also put your baby at risk.

Prevention is the best approach. If you want to become pregnant, it’s important to focus on undergoing treatments for hepatitis C before conceiving, if possible.

While transmission rates from mother to baby during pregnancy are low, the risk is still there.

Taking a proactive stance before getting pregnant and undergoing routine prenatal care are critical factors that can improve outcomes for both you and your baby.