Hepatitis C 101: HCV and Pregnancy – testing and impact

This is part 1 in our series about hepatitis C and pregnancy. Check back soon for parts 2 and 3.

Testing for HCV

All women who are considering pregnancy or who have recently become pregnant should be tested for the hepatitis C virus (HCV). This is especially true if someone has HCV but has not experienced significant liver disease yet, because the majority who have the infection experience no symptoms and will not know they have the infection without proper testing.

If you are having a hard time getting pregnant, you may want to consider getting tested for HCV, because HCV-related liver disease and cirrhosis can cause some fertility issues in the form of abnormal menstrual cycles, anovulation (the failure of the ovary to release an egg over a period of time), excessive estrogen production, dysfunctional bleeding, or endometrial hyperplasia. If you are experiencing any of these symptoms, a blood test can determine if they are the result of complications from the hepatitis c virus.

Should you already know your HCV-positive status and become pregnant, naturally then, the next questions you’ll want ask is how the pregnancy will affect your infection, if at all; how the infection will affect your pregnancy, your unborn child, and your delivery; if you can still breastfeed once the child is born; and if there are any special consideration when/if your child is diagnosed with HCV. While anyone who has tested positive for HCV should consult with their physician as early as possible to establish a plan for prenatal care, this rest of this guide will give you a general idea of what to expect throughout the process.

Early Assessments while Pregnant and HCV-Positive

As soon as you are diagnosed with HCV, you should consult your physician to establish a prenatal care plan. The good news is that normally, being pregnant does not affect the course of an HCV infection – pregnancy itself does not generally speed the disease’s progress, and it rarely makes the infection worse.

However, the effects of an HCV infection on a woman’s reproductive health system will be different for everyone and will depend upon the status of your specific infection. That is why an early assessment is important for all women who are pregnant and who are HCV-positive – a comprehensive assessment and prenatal care plan will take into consideration your general physical health and your liver’s health, and then your physician can determine if you’re likely to benefit from a multi-disciplinary team approach.

The Effects of Pregnancy on an HCV Infection

Although there has been very little research done on how pregnancy affects the course of an HCV infection, the majority of women tend to have little if any noticeable changes to the progression of their disease. Most women remain asymptomatic during pregnancy, and fewer than ten percent of those who have been observed have been documented displaying elevated transaminases (elevated ALT liver enzymes), indicating possible inflammation of the liver. In fact, most cases have shown a decrease in the ALT enzyme during pregnancy, which then rebounds postpartum. It is thought that the natural production of interferon by the fetus and placenta might have something to do with the HCV infection remaining benign during pregnancy.

Less Common Complications

Rarely, women who are pregnant, HCV-positive, and who have evidence of advanced liver disease may experience some additional complications such oesophagal varices (abnormal, enlarged veins in the lower part of the esophagus that develop when normal blood flow to the liver is obstructed by a clot or scar tissue in the liver) and coagulopathy (a condition in which the blood's ability to clot or coagulate is impaired). These complications can pose an increased risk of excessive bleeding during delivery or the possibility of a rupture.

Cholestasis of Pregnancy

It has also been noted that cholestasis of pregnancy may be more common in women with HCV. Cholestasis of pregnancy is when there has been an impairment of the flow of bile, a digestive fluid produced by the liver, and it usually occurs in late pregnancy. Although it triggers intense itching, most commonly on the hands and feet, but it can be on many other parts of the body as well, it poses no long-term risk to the expectant mother. For a developing baby, though, cholestasis of pregnancy can be dangerous, and doctors will sometimes recommend an early delivery.

Acute Fatty Liver of Pregnancy

If the liver is already weakened by scarring from cirrhosis, there is a chance that pregnancy may increase the risk to the expectant mother of developing a condition called acute fatty liver of pregnancy. Acute fatty liver of pregnancy can be related to liver disease and a deficiency in the production of the enzyme that allows pregnant women to metabolize fatty acids. The condition’s severity can escalate quickly, and it may also affect the unborn child who can be born with a deficiency in this enzyme, so doctor’s may recommend a quick delivery with follow-up treatment in intensive care. Normally, if the liver damage to the mother is not severe, she will be able to recover quickly.

All instances of HCV-related risks and complications will be managed by your physician on a case-by-case basis, taking into consideration your specific comprehensive assessment and prenatal care plan.1-4

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