Hepatitis C (HCV) in Pregnancy – Symptoms, Risks & Treatment

Hepatitis C is a chronic infection that affects the liver and, if untreated, can cause liver damage, liver failure, and liver cancer (1). Some children get infected with hepatitis C at the time of birth. So, when you are pregnant, the diagnosis of hepatitis C becomes important. Although the rate of transmission of hepatitis C virus in pregnancy to the foetus is 5% (1 in 20 people), it may still pose risks to pregnancy (2). Many women with hepatitis C who become pregnant usually have a healthy pregnancy in which the HCV does not transmit to the foetus. Let us look at some information that can help you learn more about hepatitis C in pregnancy, causes, symptoms, treatment, prevention, implications, and more.

What Is Hepatitis C?

Hepatitis is a liver infection caused by the hepatitis C virus. It leads to inflammation of the liver. The virus typcially does not go away without treatment, and it can lead to serious liver damage if not treated over time (3). Hepatitis is of five main types: hepatitis A, B, C, D, or E. A pregnant woman can be infected with hepatitis C when she is exposed to the bodily fluids or blood of a hepatitis-infected person.

Should You Get a Hepatitis C Test Done During Pregnancy?

Pregnant women with a dormant hepatitis C infection, in particular, might deliver their babies without being aware that they were infected. The transmission of the virus from mothers to infants is one of the largest contributors to childhood hepatitis C infection. Therefore, during pregnancy, it is good to have a blood test done (4). An anti-HCV test in pregnancy is used to determine whether you are infected with hepatitis C or not.

Doctors usually test pregnant women if they suspect that they are at risk of hepatitis C. Women who have used intravenous drugs or come in contact with contaminated needles are at risk and must be screened before getting pregnant and during pregnancy.

The good thing to know is that generally, men have a higher likelihood of contracting hepatitis C compared to women and are less vulnerable to clearing the virus during the initial phase of infection. Estrogen could provide a protective benefit for women who are of childbearing age (5).

Symptoms of Hepatitis C in Pregnancy

The symptoms of hepatitis C are not very clear and do not show themselves for many years after the patient has been infected. People with the virus in their liver for more than 6 months are known as hepatitis C carriers. Many of these carriers live for many years without major health problems.

When a person is infected, initially, they might feel extremely tired and unwell. The only sure way to confirm whether or not you have HCV in pregnancy is to get a blood test done.

Sometimes, there are no symptoms at all. In other cases, there might be mild or unclear symptoms that can be confused with symptoms of something else. However, the virus can silently cause liver damage. If not treated at the right time, it can ultimately lead to cirrhosis (a liver disease) or liver cancer.

Symptoms appear only after the virus has caused enough damage to the liver. You might have some of the following symptoms if you are affected by chronic hepatitis (6):

• Tiredness
• Muscle aches
• Nausea
• Depression
• Pain over the location of the liver, which is at the top right-hand side of your tummy
• Poor concentration or memory
• Some people get affected by jaundice
• Bleeding easily
• Bruisong easily
• Dark coloured urine
• Itchy skin
• Swelling in the legs
• Weight loss
• Poor appetite
• Confusion, drowsiness and slurred speech, called hepatic encephalopathy.
• Spiderlike blood vessels on the skin, called spider angiomas

How Does Hepatitis C Spread During Pregnancy?

Women with risk factors for hepatitis C must be screened during pregnancy. If a woman is diagnosed with hepatitis C, she will want to know if it can be transmitted to the baby. As per a report, hepatitis affects 0.6%–2.4% of all pregnancies, with an overall mother-to-infant transmission rate from 8% to 15%. Another study states that the transmission rate from mother to infant still remains as low as 1–8 % (7).

Factors existing before, during, or after pregnancy can lead to an increased risk of hepatitis C-pregnancy transmission from the mother to the baby. Some of these factors include vaginal or perineal lacerations, a higher viral load during delivery, and HIV co-infection.

HIV co-infection is an important factor that increases the chances of a mother transmitting the virus to her child if she is also infected with HIV. The rate of transmission for pregnant women with hepatitis as well as HIV is around 17 to 25 per cent. But the risk of transmission is between 0 to 18 per cent if a mother is HIV negative and does not have a history of blood transfusions or intravenous drug use.

HCV infection also spreads from using intravenous drugs and tattoos, where the needles and paints are not sterilised appropriately.

What Are the Causes of Hepatitis C in Pregnant Women?

The following are the major causes of hepatitis C transmission. Please note that these causes are not limited to pregnant women (4):

• Dental or medical procedures using equipment that is not sterilised properly.
• Blood transfusions from blood that is not screened can lead to a higher risk of spreading hepatitis C. Legally, hepatitis C screening for blood products is mandatory in India. However, it may not always be done effectively.
• Reusing syringes.
• Exposure to contaminated blood.
• Using contaminated needles similar to the ones that are used for body piercing or tattoos.
• Sharing accessories such as scissors, razors, toothbrushes, etc., with an infected individual.
• Having sexual relationships with an infected person.

Note: Drug usage and sharing spoons, needles and filters while injecting drugs is also a common cause of hepatitis C infection.

Diagnosis of Hepatitis C in Pregnant Women

Diagnosis of hepatitis C is done through a blood test. The test is not one of the routine tests taken by all expecting women. But in some hospitals, this test is conducted along with other basic tests.

Furthermore, the doctor will recommend an HCV test during pregnancy if there are risk factors. If you are concerned about being infected, you should consult your doctor for testing.

If you have hepatitis C, you might not have any symptoms at all. Or, you might have symptoms like flu, fatigue, nausea, aching muscles, anxiety and depression, which can be mistaken for something else. A blood test is the only way to get a confirmed diagnosis.

Generally, there are two tests to determine whether you are infected with hepatitis C. The first test is known as an “antibody” test or anti-HCV test. This test checks for antibodies to HCV in your body. Antibodies are particles that your body makes to fight off infections. A positive antibody result indicates that you have been exposed to the hepatitis C virus and have developed antibodies to fight off the virus. This test does not conclude that you have a chronic hepatitis C infection.

If the antibody test is positive, then a second test called the hepatitis C viral load test is performed to check if you still have the hepatitis C virus in your body. A positive result in this test indicates that you have chronic hepatitis C, and you might eventually have health problems from the virus.

Treatment for HCV While Pregnant

There are different strains of hepatitis C, and the hepatitis C treatment during pregnancy varies depending on which one you have. It also depends on the viral load and whether the liver is affected or not.

Unlike hepatitis A or B, there is no vaccine to cure hepatitis C. Thus, prevention from this virus focuses on avoiding risk factors (8).

If you are pregnant, you can’t take the usual medicines that are prescribed for treating hepatitis C. So, if you’ve been diagnosed with hepatitis C, your doctor might recommend some guidance for the management of hepatitis C, such as waiting until the baby is born before starting the treatment. Sometimes, you might be advised to wait because there are chances that your immune system might kill the virus within a few months, ruling out the need for treatment.

An acute hepatitis C infection does not necessarily progress to a chronic condition. Some individuals may eliminate the virus from their system following the acute stage, a process known as spontaneous viral clearance. Antiviral treatment can also aid in clearing acute hepatitis C (6). Antiviral treatment of hepatitis C is started once women have given birth and stopped breastfeeding (9).

While you wait, it is advisable to reduce the harm to your liver by making lifestyle changes such as the following:

• Stop or limit the consumption of alcohol, as alcohol can be harmful during pregnancy and even otherwise.
• Quit smoking.
• Eat a healthy and balanced diet.
• Exercise regularly.

For the treatment of hepatitis C, medications called Pegylated interferon (PEG-INF) and ribavirin are used. Sometimes, another drug called boceprevir or telaprevir might be included with the combination of the two drugs. However, all these drugs are unsafe in pregnancy. Ribavirin can cause severe birth defects and sometimes even lead to the death of the baby.

Effect of HCV on Pregnancy

Research suggests that babies born to women with hepatitis C might be born premature, have low birth weight, and may face a risk of intrauterine growth restriction (IUGR). The mothers might have liver-related issues or might encounter pregnancy-related difficulties.

An analysis conducted by the US Nationwide Inpatient Sample, Reddick et al, indicated an increased risk of gestational diabetes, preterm birth and caesarean delivery in women suffering from Hepatitis C during pregnancy (7). Pregnant women with cirrhosis have a higher likelihood of adverse maternal outcomes (such as preeclampsia, the need for cesarean delivery, complications from bleeding, and mortality) as well as negative neonatal outcomes (including preterm birth, low birth weight, and neonatal mortality) (10).

If women infected with Hepatitis C want to try for a baby, it’s important for them to wait until the treatment is completed. Such women are at risk of having a baby with birth defects. Therefore, during treatment, they would need effective birth control until the doctor advises that it is safe to try having a baby. Ribavirin might also affect sperm, so consult your doctor and take their advice. Treatments that include interferon therapy must also be discontinued during pregnancy because the effect of this therapy on the baby is still unknown.

Will Hepatitis C Affect My Baby?

The chances of transmitting Hepatitis C to a baby that is in the uterus during pregnancy or at childbirth are low. But the probability of the baby catching Hepatitis C increases, from 5% to 10-15%, if the mother has another infection, such as HIV or hepatitis B (11). Although the chances of your baby getting infected are less, it is good to get the baby tested for it when he or she is one year old. Tests done before one year of age fail to show conclusive results.

If the baby is infected with Hepatitis C, a specialist who treats children for Hepatitis C should be consulted to provide ongoing care. The child might need ultrasound scans or related tests coupled with regular tests and check-ups. Medication is not given to all children affected with Hepatitis C. The treatment varies from child to child and depends on what is best suited for the infected child. Women with the infection might also need antiviral drugs after childbirth.

Babies whose mothers have Hepatitis C are born with antibodies to the virus in their blood. However, these antibodies disappear over time if the baby has not been infected.

How to Protect Your Baby From Getting Hepatitis C

As discussed earlier, if you have Hepatitis C, there is a 1 in 20 chance that you will transmit it to the baby. The risk is higher if you are also affected by HIV and are not taking treatment. Unfortunately, there is no way to prevent the spread of Hepatitis C to the baby.

What Are the Long-term Effects of Hepatitis C?

Hepatitis C is an infection that can easily go undetected for a long time since it often shows minimal or no symptoms. While sometimes, the body might clear the Hepatitis C virus, it is also possible that it might remain in the liver. Hepatitis C carriers are people who have had the virus within them for more than six months. There is a chance that some of them may develop cancer of the liver or liver cirrhosis. These complications usually occur after many years of being infected by the virus.

Complications Associated With Hepatitis C

Pregnant women infected with Hepatitis C might be affected with liver-related complications and pregnancy-related complications.

Infants born to Hepatitis C-infected women may also have low birth weight and might need to be under assisted ventilation with intensive care facilities.

Important Facts About Hepatitis C and Pregnancy

Here are some important facts with respect to Hepatitis C and pregnancy.

• The transmission of the Hepatitis virus to the child is related to the levels of RNA in the mother’s blood.
• Women who are HIV positive and get infected with the Hepatitis C virus have a higher risk of transmitting the virus to their babies.
• There are no preventive methods that can minimise the transmission of Hepatitis C to the baby.
• During pregnancy, some medication must be discontinued. For example, interferon therapy for treating Hepatitis C must be stopped. It is also recommended that women should not become pregnant while they are undergoing interferon and ribavirin treatment. These medicines increase the risk of birth defects. Avoid breastfeeding during this treatment.

FAQs

1. Can you breastfeed if you have hepatitis C?

Breastfeeding is safe if you have Hepatitis C, unless you are HIV positive. There is a risk of transmission of the infection to the baby if your nipples are cracked or bleeding. So, do not breastfeed until the bleeding has stopped and your nipples have healed (12). If you are taking medication for Hepatitis C, you might be advised not to breastfeed your baby because the medication can be passed into the milk. It is always advisable to consult your doctor before you begin breastfeeding.

2. If I have HCV, should I get my baby tested, too?

It’s possible to transmit the hepatitis C virus to your baby if you are living with hepatitis C. Inform your baby’s paediatrician that you had hepatitis C during your pregnancy so they can make sure your baby receives the necessary testing and follow-up care. The only way to determine if your baby has hepatitis C is through a blood test, specifically the hepatitis C RNA test. This testing can be conducted during a routine well-child visit between the ages of 2 and 6 months (2).

3. What to do if my baby has hepatitis C?

If your little one has hepatitis C, consult a paediatrician for regular checkups and vaccinations. Your little one can be treated for hepatitis C once they reach three years of age. Since hepatitis C does not spread by close contact, your child can comfortably play with other children and go to childcare or school (2).

4. Will I require a Cesarean delivery if I have hepatitis C during pregnancy?

Not necessary. Infected pregnant women with hepatitis C can have both vaginal as well as cesarean delivery (2).

Advancements in medical technology and research are sure to change the paradigm of treating Hepatitis C, especially in pregnant women and children. It is always advisable to consult your doctor if you suspect that you are at risk of catching Hepatitis C or are infected with Hepatitis during pregnancy.

References/Resources:

1. PubMed Central – Hepatitis C Prevalence and Birth Outcomes among Pregnant Women in the United States: A 2010–2020 Population Study

2. New York State Department of Health – Hepatitis C Testing During Pregnancy

3. Cleveland Clinic – Hepatitis C

4. CDC – Hepatitis C General Information

5. MDPI – Like a Rolling Stone? A Review on Spontaneous Clearance of Hepatitis C Virus Infection

6. Mayo Clinic – Hepatitis C

7. PubMed Central – Hepatitis C Virus in Pregnancy and Early Childhood: Current Understanding and Knowledge Deficits

8. CDC – Hepatitis C Basics

9. ACOG – Viral Hepatitis in Pregnancy

10. American Association for the Study of Liver Diseases – HCV in Pregnancy

11. Cincinnati Children’s – Hepatitis C and Your New Baby

12. UpToDate – Vertical transmission of hepatitis C virus

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