Hepatitis C and pregnancy

If you have hepatitis C and are pregnant or planning to become pregnant, the good news is that the risk of passing the virus to your baby is low, around 5%. Most babies born to mothers with hepatitis C are not infected, and pregnancy on its own does not worsen the liver disease.

Hepatitis C is a liver infection caused by a virus that spreads through blood. Many people carry it without knowing, because for years it causes no symptoms. When a woman with hepatitis C becomes pregnant, specific questions come up: whether the baby will be infected, whether it can be treated, how the delivery should be handled and whether she can breastfeed. This article answers those questions with current information.

Can you pass hepatitis C to your baby?

The main concern is vertical transmission, meaning the passage of the virus from mother to child. It happens around the time of delivery and, as a general rule, does not cross the placenta. The average risk is about 5%. A review that pooled more than one hundred studies estimated a rate close to 6% in mothers with detectable virus in the blood and without HIV.

Put another way, more than 19 out of every 20 babies born to mothers with hepatitis C are not infected. The risk is not the same for everyone and rises in two situations:

• Coinfection with HIV. Having HIV alongside hepatitis C roughly doubles the risk of transmission to the baby.
• High viral load. The more virus circulating in the mother’s blood (higher viral load), the greater the chance of transmission. If the PCR is negative (no detectable virus), the risk of infecting the child is very low.

Breastfeeding does not increase the risk of transmission, and the mode of delivery does not meaningfully change it either in mothers without HIV.

Who should be tested for hepatitis C?

Current guidance is to screen for hepatitis C in every pregnancy, meaning the test is offered to all pregnant women and not only to those with risk factors. The reason is simple: many women carry the virus without knowing and without any history that would raise suspicion. This universal screening is now the approach recommended by maternal-fetal medicine guidelines.

The initial test is the detection of anti-hepatitis C antibodies in the blood, which is highly sensitive. A negative result rules out the disease in practice. If antibodies are positive, this must be confirmed by detecting the virus with PCR (which measures the virus’s genetic material), because some people had the virus and cleared it, and in them the antibodies remain positive even though they are no longer infected.

Keep in mind that during pregnancy the liver enzymes tend to fall in women with hepatitis C, so a normal result does not rule out the infection.

Can hepatitis C be treated during pregnancy?

Hepatitis C is now curable with direct-acting antivirals, oral treatments of 8 to 12 weeks that are highly effective and well tolerated. However, these medications are not given during pregnancy, because safety data for the developing baby are still lacking. For that reason, antivirals are not started in a pregnant woman outside of a clinical trial.

The best approach is to get the timing right:

• If a woman with hepatitis C is planning a pregnancy, the best option is to be treated and cured before trying to conceive. Once cured, there is no risk of passing the virus to a future child.
• If the diagnosis is made during pregnancy, treatment is postponed until after delivery. The postpartum period is a good opportunity to treat and cure the infection, and it also protects future pregnancies.

If you became pregnant while taking antivirals, do not be alarmed, but talk to your doctor soon to decide together whether to continue or stop treatment.

There is no vaccine against hepatitis C and no immunoglobulin or antiviral that can be given to the newborn to prevent infection. What is recommended, on the other hand, is vaccination against hepatitis A and hepatitis B for the mother with hepatitis C who is not immune, and screening for other sexually transmitted infections.

How should the delivery be handled?

A cesarean is not indicated simply because of hepatitis C. The mode of delivery is decided on the usual obstetric grounds, just as in any pregnancy. In mothers without HIV, the risk of transmission is similar with vaginal delivery and cesarean.

During labor it is recommended to avoid invasive fetal monitoring (the electrodes attached to the baby’s scalp) and early artificial rupture of the membranes, unless they are necessary, because they could increase the baby’s contact with maternal blood.

Can you breastfeed?

Yes. Hepatitis C does not contraindicate breastfeeding and does not change the usual breastfeeding recommendations. The only precaution is to temporarily stop feeding from the affected breast if there are cracked or bleeding nipples, because in that situation there may be contact with blood. Once healed, breastfeeding resumes without any problem.

How is the newborn followed up?

Every newborn of a mother with hepatitis C carries the mother’s antibodies in the blood, even if not infected. That is why testing the baby follows a specific timing:

• The anti-hepatitis C antibodies only become useful to rule out infection from 18 months of age, once the maternal antibodies have disappeared.
• As an alternative for an earlier diagnosis, the virus can be measured by PCR from 2 to 6 months of age.

Children who do acquire the infection usually have a benign course, without symptoms and with normal or mildly elevated liver enzymes during childhood. In addition, curative treatments are now approved for children, so an early diagnosis makes it possible to plan their cure.

Does hepatitis C affect the pregnancy?

In general the liver disease stays stable during pregnancy and does not increase the risk of malformations. An association with preterm birth and lower birth weight has been described, so prenatal care should be the usual, attentive follow-up. It is very uncommon to find advanced liver disease (cirrhosis) in a pregnant woman with hepatitis C.

Practical recommendations

If you are found to have hepatitis C during pregnancy:

1. Confirm it with PCR to see whether the virus is active.
2. Complete the workup: HIV, hepatitis B and other sexually transmitted infections, liver tests and evaluation by a hepatologist.
3. Delivery is decided on obstetric grounds; hepatitis C does not require a cesarean.
4. You can breastfeed, except with cracked or bleeding nipples.
5. Plan antiviral treatment for after delivery, which today cures the infection in the vast majority of cases.
6. Follow up the newborn with the tests at the recommended times.

See also

• Hepatitis C
• Hepatitis C and HIV coinfection
• Hepatitis C FAQ
• Liver enzymes (ALT and AST)