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Hepatitis C Information for Pregnant Women

What is hepatitis C?

Hepatitis C is a liver disease caused by a virus first identified in 1989. The hepatitis C virus or HCV for short, is spread mainly when people share blood or body fluids containing blood.

Hepatitis C is different from hepatitis A and hepatitis B.

How does someone get hepatitis C?

Injection drug use is the most common way of getting hepatitis C. Less commonly, tattooing, body piercing or acupuncture in less-than-sterile conditions or sharing a toothbrush or razor with an infected person can spread the virus.

Although transmission of hepatitis C from unprotected sex is rare, it is not absent. The risk increases when there are open sores and during menstrual periods. Safe sex should be practised at all times to minimize acquiring other infections.

A pregnant woman can just as easily get infected through all the routes mentioned above.

If I have hepatitis C and get pregnant, can I pass it on to my baby?

The risk of HCV transmission to the baby is low compared to other viruses such as hepatitis B or HIV. Approximately 5 out of 100 mothers who have HCV might pass it to their babies before or at the time of birth.

If a mother has both hepatitis C and HIV, the risk of the baby getting hepatitis C is much higher than when the mother is infected with hepatitis C alone. Anywhere from 22 to 36 out of 100 babies born to hepatitis C and HIV positive mothers will become infected with hepatitis C.

Can I do anything to reduce the risk of passing it to my baby?

Unfortunately, there is currently no effective way to prevent or reduce the risk of hepatitis C transmission to the baby.

The mode of delivery (caesarian or vaginal) does not seem to affect the rate of transmission but firm evidence is lacking.

However, for mothers infected with both hepatitis C and HIV, there are medications that can significantly reduce the risk of passing HIV to the baby.

Will pregnancy make my hepatitis C worse?

Most HCV positive mothers do not have any symptoms when they are pregnant. The markers in blood for the activity of HCV such as liver tests or the amount of virus count remain low in pregnancy in general but tend to increase slightly after the birth of the baby. However, symptomatic liver disease is still rare even in the postpartum period.

How will I know if my baby is infected with HCV?

There are two main blood tests used to diagnose hepatitis C. The hepatitis C antibody test, which is used to diagnose the infection in adults, is not useful in infants because their mother's antibodies, that are passively passed on to them during pregnancy, persist until they are 18 months of age.

The diagnosis in a baby is made using a test called hepatitis C RNA, which examines the baby's blood directly for the presence of the actual viral material of HCV. Although this test is very good, it may take several months after birth for the virus count in the baby's blood to rise high enough for detection. Repeated testing in the first year of baby's life is often necessary before the diagnosis can be made.

Can I breastfeed my baby safely?

HCV has been found in breast milk infrequently and the studies so far do not show that breastfeeding increases the risk of transmission of hepatitis C to the baby. Therefore, the baby CAN be safely breastfed.

However, if the nipples are bleeding or cracked, it is recommended that breastfeeding be stopped until they are healed.

If my baby is infected, how serious is it?

Most babies who get hepatitis C from their mothers are not able to get rid of the virus and many infected babies go on to develop chronic inflammation of the liver.

HCV positive babies may grow normally and feel well for many years. However, they are risk of developing scarring of the liver, also known as cirrhosis, many years later. A small proportion of those who develop cirrhosis may also get cancer of the liver.

What kind of care should my child get if s/he has hepatitis C?

A regular follow-up with a doctor experienced in dealing with hepatitis C, for example, a gastroenterologist, hepatologist or infectious disease specialist, may be desirable.

Infectious precautions should be taken, such as avoidance of donating blood or sharing toothbrushes and needles.

For those with more advanced cases of hepatitis C, there are treatments with medications such as alpha-interferon and ribavirin. However, experience with these medications in children is limited.