The hepatitis C virus (HCV) can transmit to a fetus during pregnancy, but the risk of this happening is low. And if the transmission occurs, the baby’s immune system may clear the virus on its own.

If the baby’s immune system does not clear the virus, there are safe and effective treatments that doctors can use after the child reaches 3 years of age.

This article looks at exposure to HCV before or during birth, whether the virus can affect pregnancy in other ways, and how doctors diagnose and treat the infection in children.

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HCV can pass to a fetus during pregnancy, and about 8–15% of babies born to people with hepatitis C have the virus at birth. It is worth keeping in mind that this is an estimate and that the exact rate of transmission during pregnancy is unknown. There is no way to prevent the virus from passing on.

Scientists do not fully understand at what point HCV transmits to a fetus. The likelihood of viral particles passing through the placenta is low. This suggests that the transmission may occur through contact with blood during labor.

Transmission to a fetus is more likely if the parent has a high HCV viral load, has HIV, or uses intravenous drugs.

An estimated 23,000–46,000 children in the United States have hepatitis C. About 0.15% of children aged 6–11 years are HCV positive. Most of these infections develop during pregnancy or birth.

Can males transmit HCV to a fetus?

It is unlikely that males can transmit HCV to the fetus through sperm during conception.

A 2004 review of studies investigating assisted reproduction found that while some studies have detected HCV in sperm, the evidence suggests that ejaculated sperm is usually safe to use in fertility treatments, such as in vitro fertilization.

Can HCV pass on through sex?

The Centers for Disease Control and Prevention (CDC) report that HCV can pass on through sex but that this is an uncommon route of transmission. The older review, from 2004, suggests that 5% of HCV cases are sexually transmitted.

The chance of HCV transmitting through sex increases if a person has multiple partners, has a sexually transmitted infection, or engages in sexual behavior that exposes someone to blood. Men who have sex with men may be more likely to contract HCV through sex, the CDC suggest.

Learn more about how HCV might transmit during sex.

Doctors can tell if a baby or child has HCV by performing blood tests. They may use an antibody test or a polymerase chain reaction (PCR) test. Antibody tests confirm whether a person has ever had the infection, while PCR tests measure the amount of HCV in the blood, indicating whether there is an active infection.

Typically, doctors only perform antibody tests for HCV in babies who are at least 18 months old. This is because babies have maternal antibodies in their blood until this time, which can affect the results.

In some cases, a doctor may test for HCV earlier. They can administer a PCR test after a baby is 3 months old.

If a baby tests positive for HCV, they may require monitoring from a doctor with experience treating hepatitis C in children. This may mean a consultation with a pediatric hepatologist.

The pediatric hepatologist will monitor the baby’s growth and assess their viral load with a blood test. This determines how much of the virus is in the body.

A doctor will also determine the genotype of HCV. There are six of these genotypes, and doctors sometimes use different drugs to treat different types.

Before and during the treatment, doctors will periodically check the child’s liver function. They may also recommend vaccinations for hepatitis A and B, as having multiple types of hepatitis increases the risk of liver damage. Children with HCV should also receive annual flu vaccinations.

How do HCV genotypes help determine treatment? We explain.

The main treatment for HCV is direct-acting antiviral (DAA) therapy. This involves taking antiviral drugs. Doctors generally do not recommend these drugs during pregnancy, as it is unclear whether they can affect the fetus.

Doctors are also unsure of the effects of DAAs on babies during breastfeeding. For this reason, adults begin or resume hepatitis C treatment after they have finished breastfeeding.

Children with HCV typically do not begin treatment until they reach 3 years of age. However, by the age of 2, there is a 40% chance that the immune system has cleared the virus on its own.

If this does not happen, or if the child has signs of aggressive liver disease that could progress, doctors may begin DAA treatment as soon as possible. The specific drugs involved can depend on the genotype of HCV.

Children usually respond well to the treatment and experience minimal side effects. After 12 weeks of treatment, around 90–95% of children with genotype 1 HCV have no detectable viral load in their blood, for example.

Some evidence suggests that people with HCV have a higher risk of certain pregnancy complications. These include:

  • gestational diabetes
  • preterm birth
  • low birth weight in babies

This may mean that babies born to people with HCV are more likely to require neonatal intensive care.

However, most people with HCV do not experience complications during pregnancy. Sometimes, pregnancy can actually decrease a person’s viral load due to the changes that take place in the immune system.

After giving birth, there are a number of ways to prevent the transmission of HCV:

  • Breastfeeding: HCV is a blood-borne virus. People with it can breastfeed safely, but they should stop if their nipples crack or begin to bleed. In this case, use formula or donated milk until the nipples heal and discard any expressed milk safely.
  • Physical touch: Casual contact cannot transmit HCV. It is safe for anyone with the infection to hold and cuddle a baby unless they have blood on them, such as from an open wound. For example, if a person with HCV has a cut on their hand or a sore in their mouth, it may not be safe to touch or kiss a baby. Keep open wounds completely covered until they heal and wash away any blood on the skin with soap.
  • Hygiene: Clean up any blood spills or stains immediately while wearing clean rubber gloves, and sterilize the area with bleach and water. Do not share personal items, such as nail clippers or toothbrushes, with others.

If someone has HIV and HCV, a doctor may advise against breastfeeding.

Up to 40% of children who test positive for HCV clear the virus without any treatment before they reach 2 years of age. And children can sometimes spontaneously clear the virus until the age of 7.

If this does not happen, a child may receive a diagnosis of chronic hepatitis C. Around 80% of these children have no or mild scarring of the liver by the time they turn 18, and most have no or mild symptoms of hepatitis C. About 20–25% of children who acquire HCV before or during birth have a more aggressive form of the disease.

Researchers still do not fully understand the long-term outlook for children with HCV because of a lack of long-term studies with follow-ups lasting 20 or 30 years.

HCV can transmit to a fetus during pregnancy or birth, but the risk of this is low. If a baby tests positive for the virus, their immune system may clear the virus on its own in a few years.

For babies who test positive for HCV and do not clear the virus, treatment can begin after the age of 3. Children usually respond well to the medication and experience minor side effects, if any.