15 Facts You Need to Know About Hepatitis C and Pregnancy
Although Baby Boomers are at highest risk for Hepatitis C virus (also known as HCV)—mostly due to receiving blood transfusions before 1992 when routine screening began— the infection is actually increasing in women ages 20 to 40.
Yep, the same age range when women often get pregnant.
Screening for HCV isn’t standard for prenatal care, but if you’re at high risk for the virus—if you have HIV, injected drugs in the past (or present), or had a sexual partner who’s been diagnosed with HCV—it’s a good idea to get checked before or after becoming pregnant. Here’s what else you need to know to keep yourself and your future baby healthy.
It’s Best to Treat Infections Before You Conceive
You don’t need to be an M.D. to know this is true, but it’s best to have treatment for any infection, including HCV, before you start trying. Ideally, you would do the usual course of antiviral treatment—generally between eight to 12 weeks—and be cured of HCV before pregnancy. Of course, that’s the ideal goal. If this info is coming too late, i.e. you’re already pregnant and just got diagnosed, read on.
There Are No Safe Treatments for HCV During Pregnancy
So you’re pregnant and learn you have HCV from one of these tests: An anti-HCV antibody test, which shows you’ve had the virus, or an HCV RNA test, which shows you currently have an infection from the virus. You probably knew you were at risk but never had any symptoms, which most people don’t, according to the Centers for Disease Control and Prevention (CDC). Now what?
You likely won’t receive antiviral therapy to cure HCV if you’re pregnant. The safety of that treatment hasn’t been established during pregnancy, says Janet Luimes, N.P., a nurse practitioner at Copeman Healthcare Centre in Vancouver, Canada.
But Being Pregnant Does Have a Protective Effect
What WILL happen if you have HCV and you’re pregnant?
Your doctor will likely watch and wait to see if you develop symptoms (such as chronic fatigue or depression), which will be treated with other types of medicine, just not anti-virals.
In the meantime, try not to stress: 15% to 25% of people with HCV clear the virus without treatment, and HCV is usually somewhat suppressed while pregnant, Luimes notes. That’s because your immune system is working super hard to keep you healthy, and that prevents the virus from replicating as much as it would if you weren’t pregnant.
Being Cured Is Not the Same as Being Immune
Say you’ve cleared the infection on your own or with meds. Great! Now you have to avoid the behaviors/situations that led to infection in the first place. Once you’ve had HCV, the antibodies stay in your system for life, says Alina Allen, M.D., a gastroenterologist at the Mayo Clinic in Rochester, MN. But they don't make you immune. Be sure, then, to continue HCV regular screenings if those old habits prove hard to break.
You Will Not Automatically Transmit HCV to Your Baby
If you’re not finished with your HCV treatment, or you didn’t know you had HCV before getting pregnant, it’s natural to feel anxious about transmitting the virus to your baby, a process known as “vertical transmission.” Vertical transmission can happen when a disease-causing agent (known as a pathogen) is transmitted from mother to baby. In the case of HCV, it would be transmitted through blood.
Any type of sexually transmitted infection can pose serious health risks during pregnancy, but keep in mind that the chances of HCV transmission to your baby are only about 5%, says Gerardo Bustillo, M.D., an ob/gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. Experts aren’t sure why the risk is so low, but it is.
Your Risk of Infection Depends on Your RNA Level
Another aspect to consider is that the risk of a woman passing HCV to her baby depends on the levels of RNA (the virus’ genetic material) in her blood. Risk of transmission is highest in women with HCV RNA greater than 1 million copies/mL (normal levels start at 15 copies/mL). RNA levels vary from person to person, so your risk of transmission may be even lower than you may think. Your doctor can check your RNA level with the hepatitis C virus RNA test, a blood test.
Your Risk of Transmission Increases With HIV
There ARE certain factors that make vertical transmission more likely, Dr. Bustillo says, especially if a mother is also HIV positive. Having STDs and a history of intravenous drug use can also increase your risk since it means your immune system may be compromised. Talk with your doctor about the best plan for addressing these risks, which may include additional pre-pregnancy antiviral treatments.
You’re at Higher Risk of Adverse Birth Outcomes...
You’re wondering what else you should be concerned about with HCV while pregnant. It’s this: You might have a more difficult time when the baby is born, says Dr. Bustillo. A meta-analysis and two population-based, retrospective cohort studies found that babies born to those with HCV were more likely to have poor birth outcomes—including fetal growth restriction, low birth weight, congenital anomalies, and preterm births. That's why having a top-notch medical team is key.
...But There IS Something You Can Do About It
Add the right doctors, meaning those who specialize in the liver and liver health, to your healthcare team. Find a hepatologist or infectious-disease specialist experienced in the management of hepatitis. They can help you understand your risks and manage your care with your ob/gyn and primary-care doc. They can also educate you and your doctor about what should and, more importantly, SHOULDN’T, happen during your delivery (more on this next).
The Type of Delivery Doesn't Seem to Have a Significant Impact...
Because HCV is transmitted through blood exchange, a baby may not have vertical transmission during pregnancy, but he or she can be infected during delivery. Dr. Bustillo says research about the type of delivery—vaginally or by cesarean—has not been conclusive as to whether one or the other increases risk (and remember that overall, your risk of transmission is approximately 5%). So, if you deliver your baby by c-section, you’re not putting your baby in more danger of HCV compared to a vaginal birth. Why? Likely because both delivery types involve blood.
...But Certain Procedures During Delivery Might
Things you do not want to happen during labor because they may be associated with an increased risk of vertical transmission, include:
- Prolonged rupture of membranes (when the amniotic sac breaks before labor either on its own or by your healthcare provider)
- Internal fetal monitoring (when your healthcare team places a monitor on the baby while it’s still in the womb)
- Episiotomy (when your doctor makes a surgical cut in the opening of the vagina during delivery)
According to recommendations on HCV and pregnancy, it’s best for healthcare providers to avoid these modes of care in HCV patients during labor.
You Can Breastfeed
You’ve safely delivered the baby.
Now, you want to breastfeed. And you can, with one caveat: Unless your nipples are cracked and bleeding, breastfeeding carries no risk of HCV transmission, Luimes says. Just make sure to express and toss any milk if and when that happens. Plus, according to the Centers for Disease Control and Prevention, if your nipples are affected, you can go back to breastfeeding once they’re healed. Your child’s pediatrician can often help you find (or even has on staff!) a lactation consultant, who can help you get a better and more comfortable latch.
Your Baby Won’t Be Tested Right Away
If you have HCV during pregnancy, the current recommendation is to wait as long as 18 months to test your baby for the infection, Dr. Bustillo notes. That’s because the baby may clear the infection without help or could develop the infection over time. Dr. Bustillo adds that waiting this length of time before testing doesn’t present any danger to the baby; the virus is slow-moving and won’t do damage in the interim. In fact, kids can have it into their teens without negative consequences.
HCV in Babies Is Highly Treatable
Perhaps your biggest fear comes true and your baby does end up contracting the virus. Although this is the worst-case scenario, Dr. Bustillo says that just like adults, about 20% of newborns with HCV will clear the virus on their own without any treatment. If the baby does need antiviral therapy (the same that adults receive), another comfort is that liver disease can take years to cause damage in children, he adds, and it’s very treatable through those antiviral medications.
It’s Normal to Worry, but Chances Are, You’ll Both Be OK
Although it’s completely natural to have a high degree of concern about passing HCV to your baby if you have the virus, Dr. Allen offers a reminder that vertical transmission rates are low, and even if you do transmit HCV, it’s considered curable. Staying on top of treatment for yourself and your baby, and making a plan with your doctor, can help ease your anxieties about long-term HCV effects.