Preventing risks during pregnancy, childbirth and breastfeeding related to hepatitis C
- Hepatitis C can be passed from parent to child during pregnancy or childbirth (perinatal transmission), but this is uncommon.
- Treatment for hepatitis C is generally not recommended when a person is trying to get pregnant or during pregnancy. In particular, treatment that includes ribavirin can cause severe birth defects and must not be taken during pregnancy or by either partner (ribavirin is known to be toxic to the sperm) for at least six months before trying to get pregnant.
- There is no evidence to suggest that hepatitis C can be passed from parent to child while breastfeeding (or chestfeeding). However, it is recommended that breastfeeding be temporarily stopped if the nipples are cracked or bleeding.
Hepatitis C can be passed from parent to child during pregnancy or childbirth (perinatal or vertical transmission), but the risk is low. The likelihood of the hepatitis C virus passing to a baby during pregnancy or childbirth is about 5% (or five out of every 100 births), although there is an increased risk for women who also have HIV.
Risks of hepatitis C treatment during pregnancy
Direct-acting antivirals (DAAs)
Treatment for hepatitis C typically uses direct-acting antivirals (DAAs). Treatment with DAAs is generally not recommended during pregnancy, when trying to get pregnant or while breastfeeding (or chestfeeding) as there is very little information on its effects on fertility or a fetus. Treatment can be started after pregnancy and completion of breastfeeding (or chestfeeding). Clinical research is being done to study the effects of DAAs on pregnancy, so the recommendations to not use DAAs while pregnant or breastfeeding (or chestfeeding) or when trying to get pregnant may change in the future. If a person taking DAAs does become pregnant during treatment, it’s important to speak to a healthcare provider as soon as possible for individual advice.
The use of contraception during DAA treatment is recommended to help prevent pregnancy. However, estrogen-containing hormonal contraceptives (such as the combined birth control pill) shouldn’t be taken during treatment with some types of DAA drugs, because of an increased risk of liver inflammation. Progestogen-only pills and non-hormonal contraceptives can be used safely with any of the DAA drugs.
Treatment sometimes includes ribavirin. Treatment that includes ribavirin is known to be toxic to the fetus and can cause severe birth defects. Because of this, ribavirin must not be taken during pregnancy or when trying to get pregnant. The use of contraception by both partners is an option to help prevent pregnancy while undergoing treatment.
A person who is planning to have a baby should wait six months after treatment with ribavirin has ended, as there is evidence that ribavirin persists in the body for up to six months. This is true for both the person planning to get pregnant and the person contributing sperm (ribavirin can also be toxic to sperm).
Some people may choose to start treatment after pregnancy, although it is recommended that a person taking ribavirin should not breastfeed or chestfeed.
Planning a pregnancy
A healthcare provider can help determine a treatment plan and timeline for people with hepatitis C who are planning to have a baby.
Some people may choose to get treated for and cured of hepatitis C before trying to have a baby. If treatment includes ribavirin, it is important to wait at least six months after the end of treatment before trying to get pregnant.
Prenatal care and childbirth
For most people, having hepatitis C does not have any impact on their prenatal care (care during pregnancy) or childbirth. If prenatal testing is required (for example, to test for conditions such as Down’s syndrome), these tests are safe and don’t carry a significant risk of hepatitis C transmission to the baby.
There is no evidence to suggest that giving birth in a particular way (vaginal birth or C-section) will increase or reduce the likelihood of hepatitis C transmission.
Breastfeeding or chestfeeding
Although the hepatitis C virus has been found in breast milk, there is no evidence to suggest that hepatitis C can be passed from parent to child while breastfeeding (or chestfeeding).
However, as hepatitis C is transmitted blood to blood, it is recommended that breastfeeding be stopped if the nipples are cracked or bleeding. Breastfeeding can be continued after the nipples are healed.
The following may help to prevent cracked nipples while breastfeeding:
- Frequently change the position of the baby at every feed.
- Place/leave a few drops of breast milk on the nipple after every feed and let the breast milk air dry. Breast milk is a natural moisturizer. Other moisturizers that are available for purchase include Vaseline and breast balms.
Testing children for hepatitis C
The likelihood of the hepatitis C virus passing to a baby during pregnancy or childbirth is about 5%.
The first step of testing for hepatitis C typically involves screening the blood for the presence of antibodies. It is usually recommended to wait until children are at least 18 months of age before doing this screening. Children who are tested for the virus before 18 months of age and while breastfeeding should be tested using an RNA test (instead of an antibody screening test). This is because the antibodies in their blood would probably have been acquired from the pregnant parent with hepatitis C and would not necessarily indicate an active infection. If a child tests positive for hepatitis C, they should have an RNA test once they are over the age of 3 years, as up to half of children with hepatitis C may spontaneously clear it without requiring any treatment.
Resources for service providers
- Hepatitis C Basics – eduCATIE online course
- Hepatitis C Treatment – eduCATIE online course
- Hepatitis C versus the immune system: the biology of hepatitis C transmission – CATIE Prevention in Focus article
Resources for clients
- Hepatitis C is passed blood to blood – CATIE postcard
- Curing hepatitis C: What you need to know – CATIE booklet