Hepatitis C Management

Ask The Experts

Question

What are the guidelines for treating a pregnant patient with hepatitis C who has a moderate viral load, including the best drug combination, the risk of transmission during delivery, and recommendations about breastfeeding?

Pregnant patients should not receive hepatitis C antiviral treatment. Ribavirin may cause severe birth defects and is contraindicated in pregnancy. Interferon is not approved for use in pregnant women. Delaying treatment until after pregnancy and breastfeeding does not jeopardize the welfare of the mother.

Mother-to-child transmission of HCV is uncommon, occurring in less than 5% of cases. Mothers with very high viral loads, especially those co-infected with HIV, have been shown to transmit HCV to their offspring more often. Hepatitis C in a pregnant woman does not mandate birth by cesarean section nor has breastfeeding (or its avoidance) been shown to correlate with mother-to-baby transmission. Some evidence suggests that rupture of the membranes for more than 6 hours before delivery is associated with a higher risk of HCV infection in the child. Common sense dictates avoiding opportunities for blood-to-blood transmission.