“Women born after 1976 have a very low risk of hepatitis C infection,” says Camilla Graham, MD, an infectious-disease specialist at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School in Boston. Dr. Graham is an expert in hepatitis C, including the special risks faced by women and children who have the infection. The CDC estimates that anywhere from 2.7 to 3.9 million Americans may have chronic hepatitis C. About 36 percent are women, but many of them don’t know they’ve been infected. Yet even without symptoms, they can still spread the infection to others — including their unborn child. Hepatitis means “liver inflammation,” and hepatitis C is liver inflammation caused by the hepatitis C virus. HCV enters the body through the blood of an infected person. According to a 2016 report in the journal Clinical Infectious Diseases, hepatitis C is the most common blood-borne disease in the United States today; it causes more deaths each year than any other infectious disease, including hepatitis B and HIV.
Hepatitis C Risk Factors
Regardless of your sex, the following factors put you at higher risk than the general population for hepatitis C infection:
Being born between 1945 and 1965Using injection or intranasal drugsHaving sex with an intravenous drug userHaving a blood transfusion, organ transplant, or surgery prior to 1992Having hemophiliaBeing on long-term hemodialysisHaving HIV infectionHaving elevated liver enzymes (alanine aminotransferase, or ALT, levels)Having been born to a mother infected with hepatitis CHaving been incarceratedAbusing alcoholHaving gotten a tattoo in an unregulated environmentBeing exposed to blood from needles or sharp objects
Baby boomers are five times more likely to have hepatitis C than other adults, according to the CDC. (The reason is that the virus circulated in the population throughout the 60s, 70s, and 80s, before it was identified, in 1989, and virtually eliminated from the blood supply, in 1992.) Today, however, about 70 percent of new cases of hepatitis C result from injection drug use, according to the U.S. Department of Health and Human Services. Furthermore, a study published in 2017 in the journal Clinical Infectious Diseases found that women who inject drugs have a 38 percent higher risk of contracting hepatitis C than men who inject drugs.
How Can We Protect Newborns From Hepatitis C?
From 2009 to 2014, the prevalence of HCV-infected women giving birth has nearly doubled, according to a 2017 report from the CDC. Pregnant women who have risk factors for infection with the hepatitis C virus should speak to their doctor about having an HCV screening test, Graham says. In some obstetric practices, it may be best to test every woman, she believes, because it’s hard to know which risks apply to each individual. An estimated 23,000 to 46,000 children in the United States have hepatitis C, Graham says, noting that the virus can be transmitted during childbirth if the newborn comes into contact with small amounts of the mother’s blood. The odds that HCV will be transmitted to the baby increase if a woman also has HIV. The risk of transmitting the viral infection to a newborn is not the same for every mother who has hepatitis C, though; however, Graham says this area is controversial. “High HCV viral load may increase the risk,” she says. “Women with HIV tend to have higher hepatitis C viral loads, which may partly explain the increased transmission risk with HIV coinfection.” Mothers who have had chronic hepatitis C but have no detectable virus in their blood cannot infect their newborn. “If a woman is hepatitis C-antibody positive,” says Graham, “but there is no virus in her blood and she is hepatitis C-RNA or viral load negative, she was exposed in the past but spontaneously cleared the infection.” In this case, the woman does not have an active infection is therefore not infectious (i.e., contagious) and cannot pass the hepatitis C virus to anyone, including a baby. “She could get infected in the future and not clear the infection,” Graham adds, “so she needs to avoid reexposure.” The mother’s condition is certainly involved in assessing the risk of infectiousness but the way in which the baby is monitored during labor is also important. Graham explains that if a woman has hepatitis C, her doctors should avoid using scalp monitors on the baby, which could cause bleeding. She adds, however, that “there is no evidence that cesarean section reduces the risk of transmission [of hepatitis C virus].” A baby born to a woman infected with hepatitis C virus should be tested at 18 months of age. Up to 40 percent of children with hepatitis C will clear the virus spontaneously without treatment, while others may need medical treatment — but not until age 3.
What Are the Pregnancy Risks of Hepatitis C Treatment?
If a pregnant woman tests positive for hepatitis C, medical treatment is generally not recommended during pregnancy. Couples in which one or both partners have hepatitis C, Graham states, need to use two effective forms of birth control during treatment. “This is why some women elect to be treated and cured before they try to get pregnant,” Graham says. “If cured, they also eliminate the small risk of transmitting hepatitis C virus to their baby.” Hepatitis C infection is a preventable — and curable — condition. If you have any of the experiences listed above that increase risk of hepatitis C infection, speak with your healthcare provider about getting a hepatitis C test.
