Hepatitis C 101: HCV and Pregnancy – Impact on baby

This is part 3 in our series about the hepatitis C virus (HCV) and pregnancy. Visit part 1 and part 2.

How will having hepatitis C affect my baby?

Currently, there’s very little data on hepatitis C infections (HCV) and pregnancy, but the data that is available suggests that a mother with HCV does not increase the risk of birth defects to her child, distress to the baby in utero, stillbirths, or premature births.

The chances of your baby contracting HCV from you are, on average, about 1 in 20 (or 5%).

It's also somewhat unlikely that you'll pass hepatitis C on to your baby, either while the fetus is in the womb or during birth. The chances of your baby contracting HCV from you are, on average, about 1 in 20 (or 5%).

HCV transmission during pregnancy and delivery

The reported rates of mother-to-fetus transmission vary from 0-36%, with an average rate of 5% in otherwise healthy women. However, if you are also infected with HIV, that rate increases up to 44%.

Some of the available evidence suggests that the greatest risk of transmission occurs during the intrapartum period – during birth – however, the factors contributing to that risk and the relevant importance of such a distinction is still being researched, and further information is needed to distinguish between risk factors while the baby is still in the womb as compared to risk factors during birth.

When viral load is above 1,000,000, the risk of transmission from mother to fetus increases from an average of 5% to as high as 36%.

Several studies, though, have documented a significantly greater risk of transmission from mother to child when the mother’s viral load is above 1,000,000/ml. When viral load is above 1,000,000, the risk of transmission from mother to fetus increases from an average of 5% to as high as 36%.

Hepatitis C and Caesarean sections

Even though a few studies have suggested a lower transmission rate after Caesarean section (c-section), the evidence is not conclusive to recommend it as a protective intervention. Women with HCV should therefore be allowed to deliver vaginally, unless obstetric reasons dictate otherwise.

Maternal antibodies

Even though there is a small chance that your baby will contract HCV, a passive transfer of antibodies (IgG) occurs to all babies born to mothers with HCV. This transmission occurs through the placenta, and at birth, your baby will test positive for HCV antibodies, but this shouldn’t raise concern. Infants who did not contract the virus will clear the antibodies on their own by 12-15 months of age. However, if the antibody level is high in the mother, then they will likely be higher in the newborn too, and they will take longer to clear.

At as early as 2-3 months of age, your baby can be tested for the hepatitis C virus to determine if they contracted the infection from you. The test looks for the virus itself with an HCV RNA test – not the antibodies that are naturally passed from the placenta. For most babies, the test will show that they do not have the virus, but at that time, they will probably still carry the antibodies.

Of course, a negative test will alleviate any anxiety you have about transmitting the infection to your child, but early diagnosis, in the case of children who contracted the infection in utero or during birth, does not typically alter the disease’s progression in the child.

Breastfeeding with HCV

HCV RNA and HCV antibodies have both been detected in colostrum and breast milk. When present, it has been in much lower concentrations than in the blood. The importance of these findings is not yet clear, and while there is a theoretical risk of transmission from a mother to her child through breastmilk, no case has yet been reported. Therefore, it is generally felt that breastfeeding is not a risk factor for transmission. Unless you also have HIV, breastfeeding with HCV doesn't appear to pass the hepatitis C virus to your baby.

Breastfeeding and HCV treatment

If you are undergoing treatment for hepatitis C, you may be advised against breastfeeding your baby, because the medication can enter your milk.

It is not known if some of the newer treatment regimens, such as Harvoni and Viekira Pak (now discontinued), can pass into your breast milk. When deciding whether to breastfeed, while taking medication for HCV, you and your physician should consider the developmental and health benefits of breastfeeding along with the clinical need for treatment and any potential adverse effects on the breastfed child.

If your baby contracts hepatitis C

If your baby contracts HCV, you should consider ongoing care from a doctor who specializes in treating children with this condition. Children who become infected with HCV during pregnancy or during birth are likely to become chronically infected, so they will need to have regular check-ups, blood tests, and possibly other tests to monitor their overall health and the health of their liver.

Recent studies that have followed up on children who were infected in utero or during the birthing process, have found, after as many as 20 years of observation, that infection in children is milder than HCV in adults.

Recent studies that have followed up on children who were infected in utero or during the birthing process, have found, after as many as 20 years of observation, that infection in children is milder than HCV in adults. Clinically, children who contracted the infection from their mothers show low to normal enzyme levels, they experience less severe liver tissue and cell changes, and they have a lower percentage of HCV RNA presence.

However, some children do have fibrosis on liver biopsy, and fibrosis progresses with age and duration of illness. Thus, it is possible that some individuals infected in early childhood will eventually progress to end stage liver disease. Similar to the comprehensive assessment that is done on a mother following an HCV diagnosis and during pregnancy, a similar assessment will be done on the child to determine the best course of treatment, based on their test results and what is best for that child.