Hepatitis C in Pregnancy: What to Do When You Test Positive for the Virus

Screening for hepatitis C has been routine for pregnant women since 2020. But testing positive for the chronic liver infection often comes as a surprise, because the virus doesn’t usually cause symptoms. If you’re pregnant and have been diagnosed with hepatitis C, you might be wondering how the condition will impact you and your baby — and how it can be treated.

First, know that hepatitis C doesn’t have to stop you from having a healthy pregnancy. “A [pregnant] woman is not at higher risk for complications from hepatitis C itself,” says Lee F. Peng, MD, chief of the division of hepatology and medical director of liver transplantation at Lewis Katz School of Medicine at Temple University in Philadelphia.

Hepatitis C is also unlikely to cause long-term liver damage when treated promptly, since oral antiviral medications can typically clear the infection within 8 to 12 weeks. Long-term liver problems, such as cirrhosis, typically don’t set in for 10 to 20 years, according to the Centers for Disease Control and Prevention (CDC).

You’ll have to wait to start treatment until after giving birth, though, because drugs for hepatitis C haven’t been cleared for use during pregnancy. “We don’t know how safe our medications are for the mother or the developing fetus in pregnancy,” says Dr. Peng. “Some small-scale studies show the meds are safe and effective, but we need larger studies to make sure.”

There’s also a small risk that the infection could be passed on to your baby: About 5 percent of infants born to women with hepatitis C test positive for the virus themselves, according to the CDC. If a woman has hepatitis C and HIV, the chance of transmitting hep C to her infant rises to roughly 10 percent. There’s no way to reduce your baby’s chances of catching hepatitis C during pregnancy, but taking the right steps now and after giving birth can help protect you both.

What You Can Do While You're Pregnant

Even though you can’t start treatment yet, it’s important to meet with a hepatologist now to assess your health, prepare, and check whether the virus has caused any liver damage. You can also talk about the time line for starting hepatitis C meds after giving birth or once you’ve finished breastfeeding.

There’s a high chance you can stay with your current ob-gyn for the rest of your pregnancy and when you deliver, says Clara Ward, MD, an associate professor of maternal-fetal medicine at UTHealth McGovern Medical School and an attending physician with Memorial Hermann Hospital in Houston. But you should meet with a maternal-fetal medicine doctor (a specialist in high-risk pregnancies) to discuss how individual risk factors related to hep C, such as liver damage, might impact your pregnancy and birth. “The specialist can provide recommendations for care for [your] primary obstetrician,” Dr. Ward says.

Your ob-gyn will also reach out to your baby’s pediatrician to let them know about your diagnosis. That way, the pediatrician can test your baby for hepatitis C at a later date and coordinate the care your child may need if they test positive.

What You Can Do During Labor and Delivery

If your baby comes in direct contact with your blood during birth, it’s possible for the infant to contract hepatitis C. While you’re in labor and delivering your baby, your care team will work to minimize this risk by steering clear of things such as internal fetal monitoring, cesarean section (C-section), and episiotomy as much as possible. “It’s recommended to avoid them unless absolutely necessary,” Ward says.

If these measures seem needed (if your team is having trouble monitoring your baby’s heart rate externally, your water breaks prematurely, or the baby is in a position that makes it difficult to deliver vaginally), you’ll weigh the pros and cons with your doctor to make the best decision for you and your baby.

What You Can Do After Giving Birth

You can start oral antiviral treatment for hepatitis C after giving birth, unless you choose to breastfeed. Hepatitis C meds haven’t been shown to be safe to use while breastfeeding, so you’ll need to wait until you’ve finished nursing to start treatment. (Breastfeeding itself is generally safe for new mothers who have hepatitis C. Because the virus is transmitted through blood, you won’t pass the infection to your baby unless your nipples are cracked or bleeding.)

If you’re not sure whether to breastfeed or begin treatment right away, talk with your ob-gyn and hepatologist. Together, you can talk about the risks and benefits to figure out a plan that works.

You won’t be able to tell right away whether your baby has hepatitis C. At 18 months, the pediatrician will check your baby’s blood for hep C antibodies, and if your child tests positive, they’ll be able to take antiviral meds when they turn three (medications aren’t approved for younger kids). The sooner treatment is started, the less likely your little one will develop long-term liver problems.