Hepatitis C and pregnancy have a complicated relationship. Pregnancy itself does not appear to worsen the course of hepatitis C infection and a woman should wait to be treated for the infection until after pregnancy. Of course, there is understandable concern of how a hepatitis C infection in a woman can affect her unborn child.
Ideally, any woman who has risk factors for hepatitis C infection (e.g., exposure to contaminated needles or injected drug use) would be screened for hepatitis C prior to or at least during the pregnancy. Many experts are now calling for universal screening of pregnant women, regardless of reported risk factors.
Overall, for every 100 pregnant women with hepatitis C, 6 of their babies will be born also infected with this disease. The chance that a pregnant woman will pass on the hepatitis C virus to her unborn child depends on how high the viral levels are in her body, along with whether or not she is also HIV-positive (which makes it more likely). In any event, a pregnant woman with hepatitis C should be under the care of a specialist who can keep a close eye on liver function tests throughout the pregnancy. And during the birth itself there are recommendations to minimize risk of vertical transmission, such as avoiding scalp monitors (which could cause bleeding). Interestingly, there is not a risk of transmission from breastfeeding.
After a baby is born to an infected mother, the child should be tested at the age of 18 months for hepatitis C. About 40% of exposed children will clear the virus on their own without treatment, while the rest will require medication to treat the hepatitis C infection. However, this treatment should not start until age 3 and there are now (fortunately) medications that can be used at these young ages. For the mother, she should be treated after — not during – the pregnancy.
Sources
Dibba P, Cholankeril R, Li AA, et al. Hepatitis C in pregnancy. Diseases 2018;6(2):E31.
Cervino L, Hynicka LM. Direct-acting antivirals to prevent vertical transmission of viral hepatitis C: When is the optimal time to treat? Ann Pharmacother April 1, 2018 doi: 10.1177/1060028018772181
