Most people with hepatitis C who become pregnant have a healthy pregnancy in which the hepatitis C virus (HCV) does not transmit to the fetus. However, hepatitis C may add to the risks of pregnancy.

The chance of HCV transmitting from a pregnant person to a fetus is about 5%. Individuals with scarring on the liver, known as cirrhosis, may also be at increased risk of pregnancy complications.

In this article, we look in more detail at hepatitis C in pregnancy. We explore the effects of HCV, how doctors treat or manage the virus, the risk of transmission, and when to speak with a doctor.

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Hepatitis C is a liver disease resulting from HCV, a virus that spreads through direct contact with blood. HCV is infectious, so it is important for people with the virus to take precautions to prevent transmission.

Hepatitis C can be acute, meaning that it lasts a short time and then resolves. It can also become a chronic infection. Over time, HCV can cause irreversible liver damage, as well as liver cancer.

However, effective treatments are available. According to the World Health Organization (WHO), antiviral medications can cure more than 95% of people with HCV infections. Seeking testing and treatment as early as possible, either before or after pregnancy, is important.

An uncomplicated HCV infection typically will not have a significant effect on pregnancy. Most people with hepatitis C have uneventful pregnancies with no complications as a result of the infection.

Some research suggests that people with HCV have a higher risk of pregnancy complications, but these studies did not control for coexisting conditions, such as substance use disorders, which could also be the cause.

However, people with cirrhosis as a result of advanced HCV may be more likely to experience complications during pregnancy and birth. These complications may include:

Pregnant people with cirrhosis should discuss these risks with their doctor.

Doctors do not generally treat hepatitis C during pregnancy. The reason for this is that few large-scale studies have looked at the potential risks of prescribing direct-acting antivirals (DAAs) — the class of drug that doctors use for HCV — to pregnant people. This lack of research means that doctors cannot confirm the safety of this treatment during pregnancy.

Some DAAs, such as ribavirin, can cause congenital abnormalities. This risk is present for up to 6 months after a person stops taking the drug.

However, small studies on other DAAs, including sofosbuvir and ledipasvir, have found no safety concerns. Doctors may consider treatment with these drugs for some pregnant individuals.

If doctors can treat hepatitis C successfully before pregnancy, this eliminates the risk of transmission to the fetus. However, continuing treatment during pregnancy can be unsafe, depending on the medication.

Although it is possible for the virus to pass from the pregnant person to the fetus, it does not occur in most cases.

However, vertical transmission to the fetus during pregnancy is the most common way for children to acquire HCV. The baby can contract HCV in the womb or during labor or the postpartum period through contact with the blood.

In about 5% of cases, the virus transmits from the pregnant person to their baby in this way. The risk increases if the person has a high viral load or also has HIV.

There are no recorded cases of HCV transmission taking place during breastfeeding or chestfeeding. However, if a person’s nipples become cracked or bleed, there may be a risk. The Centers for Disease Control and Prevention (CDC) recommend temporarily stopping nursing until the nipples heal, if this occurs.

Doctors can test for HCV once the baby reaches 18 months of age. Testing cannot take place before this point, as the baby will still have maternal antibodies in their blood, which can lead to a false positive. Once doctors determine that a baby has HCV, they can begin regular monitoring and make a plan for treatment.

The timing of HCV treatment can depend on a person’s age, the severity of the infection, and whether treatment will be safe for them.

Treatment for adults

Most pregnant adults with HCV can begin treatment after they give birth or stop nursing. At this point, doctors will retest a person for HCV to check their viral load and discuss the options for DAA treatment.

However, in some cases, treatment is not necessary. Some studies have observed spontaneous clearance of HCV in 10–25% of people during the postpartum period. Scientists believe that this may occur due to changes in the immune system during pregnancy.

Treatment for children

In 40% of cases, children with HCV clear the virus on their own by the age of 2 years. However, those who do not typically begin treatment after the age of 3 years. In special cases, doctors may begin the child’s treatment at a younger age.

Children with HCV should receive DAA treatment regardless of the severity of the infection, as this reduces the risk of severe illness later in life. Doctors will frequently monitor children with HCV to keep track of their overall health and their liver function until the virus has cleared.

DAA treatments are safe and result in minimal side effects for most people. The most common side effects include:

In the long term, untreated hepatitis C can lead to severe illness and chronic complications.

About 1 in 3 people with chronic hepatitis C develop cirrhosis within 20–30 years. This condition causes a drop in liver function, which is irreversible. The only cure is a liver transplant. Cirrhosis can also cause liver cancer by damaging cells, which can mean that they mutate and begin growing abnormally.

If a person believes that they have contracted HCV, they should seek testing as soon as possible. A doctor can assess the severity of the infection, evaluate the impact it has had on the liver, and determine how soon a person should begin treatment.

People should also speak with a doctor if:

  • they are planning to become pregnant in the future
  • they believe that their baby or child may have contracted HCV
  • there is a risk of accidental transmission to another household member
  • they use needles to inject recreational drugs, as this increases the risk of developing hepatitis C

A doctor can help create a treatment plan for adults and children. They can also carry out regular testing and monitoring, if necessary.

In most cases, hepatitis C does not have a negative effect on pregnancy. Some people find that pregnancy actually improves their viral load and that the virus clears spontaneously after giving birth.

However, there is an increased risk of pregnancy complications if a person has cirrhosis, as well as a small risk of HCV transmitting to the fetus.

Adults and babies who require treatment can take medications that effectively clear the infection, which prevents long-term complications.