Managing Hepatitis C During Pregnancy

Hepatitis C, also known as hep C or HCV, is a form of viral hepatitis. It is primarily transmitted by exposure to blood. However, it can also be transmitted from mother to child. That's why it's important for pregnant women, and women considering becoming pregnant, to be aware of the virus. (While hep C can be spread through sexual intercourse, it's much less likely to be spread by sex than through exposure to an infected needle or childbirth.)

Research suggests that pregnant women who are infected with hepatitis C have about a six in 100 chance of spreading hep C to their child. This risk is higher for pregnant women who are coinfected with both hep C and HIV—around 10 in 100.

Should I Be Screened for Hepatitis C During Pregnancy?

The Centers for Disease Control do not currently recommend that all pregnant women be tested for hepatitis C as a routine part of their prenatal care. However, they do recommend that pregnant women who have any risk factors for hepatitis C should be tested.

Risk factors for hepatitis C include:

• Being a current or former injection drug user
• Having received clotting factor concentrates made before 1987
• Having received blood transfusions or certain types of organ transplants before 1992
• Being a hemodialysis patient
• HIV infection
• Known exposure to hepatitis C, such as a nurse who has been stuck with a potentially infected needle at work.

Certain racial and ethnic groups have also been found to have higher levels of hepatitis C during pregnancy, including American Indian and Alaskan Native women. This has led for calls to broaden screening criteria for hep C during pregnancy.

Some researchers are even pushing for universal screening of all pregnant women. Studies suggest that the cost of such screening is far lower than the cost of future treatment, even with the fact that drugs are currently quite expensive. Because of this, specialist organizations, such as the American Association for the Study of Liver Diseases-Infectious Diseases Society of America, have already begun to recommend just such universal screening.

How Do Healthcare Providers Test for Hepatitis C?

Healthcare providers use one or more blood tests to determine if you are infected with hepatitis C. A hepatitis C antibody test looks for antibodies against the virus. It takes the body up to several months to produce these antibodies. Therefore, this type of blood test will not detect recent hepatitis C infections. It is not reliable until up to six months after exposure.

In addition, hepatitis C antibody tests do not distinguish between people who are currently infected with the virus and people who have been infected in the past. A positive, or reactive, hepatitis antibody test means that you have been infected at some point in time. It doesn't mean you are infected currently. A negative, or non-reactive, test means that you have either never been infected or were infected very recently.

Hepatitis C RNA tests use polymerase chain reaction (PCR) to detect signs of the actual virus in your blood. Because these tests do not need to wait for an immune response, they can detect infections much sooner after exposure. Hep C RNA tests are accurate as soon as two to three weeks after exposure. However, they are more expensive than antibody tests. Therefore, they are usually only used after someone has tested positive on an antibody test or someone has been known to have had a more recent exposure to hepatitis C. In the first case, they're used to determine whether the person was infected in the past or has a current infection. In the second, they're used to detect infections that wouldn't be caught with an antibody test.

Managing Hep C During Pregnancy

At the current time, it is not recommended that pregnant women who test positive for hepatitis C be treated for infection. The potential benefits are high, but the risks have not yet been established.

However, hepatitis C treatment has been evolving quickly over the last decade. What was once an expensive and difficult disease to treat effectively is now curable. The direct-acting antivirals that healthcare providers use to treat hepatitis C are still very expensive, but they're much more effective. They're also much less unpleasant to take than older forms of treatment.

Unfortunately, direct-acting antivirals have not yet been thoroughly tested in pregnant women. What evidence that exists suggests that the risks of using these drugs to treat hep C in pregnancy are relatively low. However, most of that data is the result of testing in animal models, and further research on drug safety is ongoing.

If it turns out that direct-acting antivirals are safe to use during pregnancy, treatment during pregnancy may turn out to be very cost-effective. It has the potential to not just reduce the long term health burden on mothers but also on their children. In addition, the prenatal period is a time when women have a lot of access to healthcare providers. That makes it a good time to undergo the somewhat extended treatment and follow-up required for hepatitis C, at least in theory.

If pregnant women with hepatitis C aren't going to be treated for the virus, why should they be tested? Because there are now effective treatments, and even cures, for most individuals with the virus. This means that women who are found to be positive for hepatitis C can be treated for the virus after they give birth. In addition, their infants can be tested for hepatitis C. That means that any children who are at risk for the sometimes serious consequences of hep C infection can be followed closely. Then they can be treated when doing so becomes appropriate.

What If My Infant Tests Positive for Hepatitis C?

Antibodies travel from mother to child during pregnancy. Therefore, if you've tested positive for hepatitis C on an antibody test, your child will too. That doesn't necessarily mean that your child has been infected with the virus. Children aren't considered to have been infected during pregnancy and birth unless they still test positive on an antibody test after 18 months or more or if they test positive multiple times on an HCV RNA test after they're 2 months old.

Scientists do not fully understand the behavior of hepatitis C in children. Most children with hepatitis C will only develop mild fibrosis, or scarring of their liver. In addition, many children's bodies will fight off the virus on their own. However, a small fraction of children infected with hepatitis C will develop cirrhosis and other liver diseases, including liver cancer. There is also some evidence that children with hepatitis C have worse overall health, including cognitive function, than their peers. Fortunately, this improves with treatment.

Currently, direct-acting antivirals have only been approved for children 12 years of age and older. Researchers are now looking at whether it is possible to use these drugs to safely treat younger children, just as there are studies to see whether they can safely treat pregnant women. For right now, the best solution for everyone is to screen and treat as many at-risk reproductive age women as possible for hepatitis C before they become pregnant. That makes pregnancy safer for both mothers and children.

A Word From Verywell

If you test positive for hepatitis C during pregnancy, don't panic. Instead, talk to your healthcare provider. While there are some decisions you will need to make over the next few months and years, hepatitis C during pregnancy is a concern. It's not a crisis. However, there are a couple of things you should know.

The first thing to know is that it's not recommended that pregnant women with hepatitis C have an elective cesarean section for the purpose of reducing the risk of their child being infected. The data just doesn't support it. Worse, the best studies disagree on whether having a C-section increases or decreases risk. Women should make decisions about how they want to give birth for other reasons, not because they're worried about hepatitis.

The second thing is that there's no reason to avoid breastfeeding if you have hepatitis C. There's reasonably good research saying that breastfeeding will not put your child at risk. Don't let a positive test for hepatitis C stop you from giving your child the benefits of breastfeeding.